Effect of Hypertension on Efficacy and Safety of Ticagrelor-Aspirin Versus Clopidogrel-Aspirin in Minor Stroke or Transient Ischemic Attack-Reference-Cited by-同舟云学术

Effect of Hypertension on Efficacy and Safety of Ticagrelor-Aspirin Versus Clopidogrel-Aspirin in Minor Stroke or Transient Ischemic Attack

Published:2022-09 Issue:9 Volume:53 Page:2799-2808
ISSN:0039-2499
Container-title:Stroke
language:en
Short-container-title:Stroke

Author:

Wang Anxin¹²,Meng Xia¹²,Tian Xue³⁴,Johnston S. Claiborne⁵^ORCID,Li Hao¹²,Bath Philip M.⁶^ORCID,Zuo Yingting³⁴^ORCID,Xie Xuewei¹²^ORCID,Jing Jing¹²^ORCID,Lin Jinxi¹²,Wang Yilong¹²^ORCID,Zhao Xingquan¹²^ORCID,Li Zixiao¹²^ORCID,Jiang Yong¹,Liu Liping¹²,Wang Feng⁷^ORCID,Wang Yanxia⁸,Huang Panbing⁹,Chen Guofang¹⁰^ORCID,Wang Yongjun¹²¹¹,

Affiliation:

1. Department of Neurology (A.W., X.M., H.L., X.X., J.J., J.L., Yilong Wang, X.Z., Z.L., Y.J., L.L., Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, China.

2. China National Clinical Research Center for Neurological Diseases, (A.W., X.M., H.L., X.X., J.J., J.L., Yilong Wang, X.Z., Z.L., Y.J., L.L., Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, China.

3. Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China (X.T., Y.Z.).

4. Beijing Municipal Key Laboratory of Clinical Epidemiology, China (X.T., Y.Z.).

5. Dell Medical School, University of Texas at Austin (S.C.J.).

6. Stroke Trials Unit, Mental Health & Clinical Neuroscience, University of Nottingham, United Kingdom (P.M.B.).

7. Departments of Neurology, Seventh People’s Hospital of Shanghai University of Traditional Chinese Medicine, China (F.W.).

8. Department of Neurology, Hejian People’s Hospital, Hebei, China (Y.W.).

9. Department of Neurology, The third People’s Hospital in Tongzhou District of Nantong, Jiangsu, China (P.H.).

10. Department of Neurology, Xuzhou Central Hospital, Jiangsu, China (G.C.).

11. Advanced Innovation Center for Human Brain Protection (Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, China.

Abstract

Background: Hypertension is a risk factor of poor stroke outcomes and associated with antiplatelet resistance. This study aimed to explore the efficacy and safety of ticagrelor-aspirin versus clopidogrel-aspirin in patients with different hypertension status, using randomized trial data from the CHANCE-2 trial (Clopidogrel in High-Risk Patients With Acute Nondisabling Cerebrovascular Events-II). Methods: A total of 6412 patients with minor stroke or transient ischemic attack who carried CYP2C19 loss-of-function alleles were enrolled and randomized to either ticagrelor-aspirin or clopidogrel-aspirin group. Hypertension status were classified into no, newly diagnosed, and previously diagnosed hypertension according to medical history, blood pressure, and antihypertensive medications during hospitalization. The primary efficacy and safety outcomes were stroke recurrence and moderate to severe bleeding risk within 90-day follow-up. Results: Ticagrelor-aspirin was associated with reduced risk of new stroke in patients without hypertension (32 [4.8%] versus 60 [7.2%]; hazard ratio, 0.55 [95% CI, 0.35–0.86]), but not in those with a newly diagnosed hypertension (20 [5.3%] versus 36 [9.1%]; hazard ratio 0.59 [95% CI, 0.33–1.07]), or those with a previously diagnosed hypertension (139 [7.0%] versus 147 [7.4%]; hazard ratio, 0.93 [95% CI, 0.74–1.18]) compared with clopidogrel-aspirin ( P =0.04 for interaction). The risk of bleeding for ticagrelor-aspirin was not associated with hypertension status (0.1% versus 0.4%; 0.3% versus 0.5%, 0.4% versus 0.3%, P =0.50 for interaction). All the efficacy and safety outcomes between treatments did not differ by blood pressure levels on admission. Conclusions: In the CHANCE-2 trial, patients without hypertension received a significantly greater benefit from ticagrelor- aspirin than those with previous hypertension after minor stroke or transient ischemic attack, and a similar benefit trend was observed in those with newly diagnosed hypertension. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04078737.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Advanced and Specialized Nursing,Cardiology and Cardiovascular Medicine,Neurology (clinical)

Reference36 articles.

1. One-Year Risk of Stroke after Transient Ischemic Attack or Minor Stroke

2. A 5-Decade Analysis of Incidence Trends of Ischemic Stroke After Transient Ischemic Attack

3. Outcomes Associated With Clopidogrel-Aspirin Use in Minor Stroke or Transient Ischemic Attack

4. Clopidogrel with Aspirin in Acute Minor Stroke or Transient Ischemic Attack

5. Clopidogrel and Aspirin in Acute Ischemic Stroke and High-Risk TIA

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