高血压对替格瑞洛-阿司匹林与氯吡格雷-阿司匹林治疗小型卒中和短暂性脑缺血发作疗效和安全性的影响。
Effect of Hypertension on Efficacy and Safety of Ticagrelor-Aspirin Versus Clopidogrel-Aspirin in Minor Stroke or Transient Ischemic Attack.
机构信息
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.
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.
出版信息
Stroke. 2022 Sep;53(9):2799-2808. doi: 10.1161/STROKEAHA.122.038662. Epub 2022 Jun 3.
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 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 (=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%, =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.
背景
高血压是不良卒中结局的危险因素，并与抗血小板治疗抵抗相关。本研究旨在利用 CHANCE-2 试验（氯吡格雷在伴有急性非致残性脑血管事件的高危患者-2）的随机试验数据，探讨替格瑞洛-阿司匹林与氯吡格雷-阿司匹林在不同高血压状态患者中的疗效和安全性。
方法
共纳入 6412 例伴有功能丧失等位基因的轻型卒中和短暂性脑缺血发作患者，随机分为替格瑞洛-阿司匹林或氯吡格雷-阿司匹林组。根据病史、住院期间血压和降压药物，将高血压状态分为无高血压、新诊断高血压和已诊断高血压。主要疗效和安全性结局为 90 天随访期间的卒中复发和中重度出血风险。
结果
与氯吡格雷-阿司匹林相比，替格瑞洛-阿司匹林可降低无高血压患者新发卒中风险（32 例[4.8%]与 60 例[7.2%]；风险比，0.55[95%CI，0.35-0.86]），但在新诊断高血压患者（20 例[5.3%]与 36 例[9.1%]；风险比 0.59[95%CI，0.33-1.07]）或已诊断高血压患者（139 例[7.0%]与 147 例[7.4%]；风险比 0.93[95%CI，0.74-1.18]）中无显著差异（=0.04 用于交互作用）。替格瑞洛-阿司匹林的出血风险与高血压状态无关（0.1%比 0.4%；0.3%比 0.5%；0.4%比 0.3%；=0.50 用于交互作用）。治疗组之间的所有疗效和安全性结局在入院时的血压水平上没有差异。
结论
在 CHANCE-2 试验中，轻型卒中和短暂性脑缺血发作后无高血压患者接受替格瑞洛-阿司匹林治疗的获益明显大于既往高血压患者，新诊断高血压患者也有类似的获益趋势。
登记
临床试验
gov；独特标识符：NCT04078737。
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