Blood pressure during long-term cilostazol-based dual antiplatelet therapy after stroke: a post hoc analysis of the CSPS.com trial
Hypertension Research ( IF 4.3 ) Pub Date:2024-07-09 , DOI: 10.1038/s41440-024-01742-3 Kazunori Toyoda , Masatoshi Koga , Kenta Tanaka , Shinichiro Uchiyama , Hisato Sunami , Katsuhiro Omae , Kazumi Kimura , Haruhiko Hoshino , Mayumi f*ckuda-Doi , Kaori Miwa , Junpei Koge , Yasushi Okada , Nobuyuki Sakai , Kazuo Minematsu , Takenori Yamaguchi , Takenori Yamaguchi , Takenori Yamaguchi , Kazunori Toyoda , Shinichiro Uchiyama , Haruhiko Hoshino , Kazumi Kimura , Yasushi Okada , Nobuyuki Sakai , Kotaro Tanaka , Kazunori Toyoda , Hiroaki Naritomi , Shinya Goto , Tatsuya Isomura , Kazuo Minematsu , Kiyohiro Houkin , Masayasu Matsumoto , Yasuo Terayama , Hidekazu Tomimoto , Teiji Tominaga , Satoshi Yasuda , Hideki Orikasa , Naoko Kumagai , Akihiro Miyasaki , Masanori Isobe , Yosh*taka Suda , Kazuo Kitagawa , Kazuyuki Nagatsuka , Shuta Toru , Makoto Katsuno , Kenichi Murao , Norio Ikeda , Kazuya Nakashima , Shinichi Okabe , Masanori Kurimoto , Ikuo Ihara , Hideki Matsuoka , Shoji Mabuchi , Hideo Hara , Teruyuki Yoshimoto , Takeshi Matsuoka , Yoshikazu Arai , Yasuyuki Iwasaki , Manabu Hattori , Kazuya Takahashi , Yoshihisa f*ckushima , Masayuki Ezura , Yasuaki Takeda , Kimihiro Nakahara , Masahiro Okada , Shingo Mitaki , Kosuke Yoshida , Kenji Kamiyama , Takahiro Kuwashiro , Takeshi Iwanaga , Akira Takahashi , Junichi Maruyama , Teiji Yamamoto , Michiyuki Maruyama , Yoshiharu Taguchi , Kazuhiro Hashidume , Katsumi Takizawa , Yasuyuki Iguchi , Kazuhito Kitajima , Shinichi Yoshimura , Syuji Arakawa , Takeshi Inoue , Hiroyuki Yamaguchi , Susumu Suzuki , Youichi Watanabe , Daisuke Yasutomi , Ryota Tanaka , Takuji Yamamoto , Tetsuo Ando , Yasuhiro Ito , Naoki Hattori , Nobutaka Yamamoto , Tsutomu Takahashi , Syoji Arihiro , Naoaki Kanda , Hirotoshi Hamaguchi , Junji Kasuya , Masaru Honda , Hiroshi Oyama , Hidefumi Yoshida , Satoshi Okuda , Keita Matsuura , Toshiaki Ieda , Takao Kanzawa , Makio Takahashi , Hirokazu Sadahiro , Takahiro Miyahara , Masahiko Yamada , Takeshi Aoki , Taizen Nakase , Katsuhiko Hayashi , Tosh*taka Umemura , Yasukuni Tsugu , Fumitaka Miya , Ryo Otani , Keiichi Yamada , Yoshinaga Kajimoto , Hiroshi Nakane , Kiyohito Shinno , Akio Hara , Ryoichi Saito , Yuzo Araki , Toshiho Otsuki , Koji Abe , Shigenari Kin , Takehisa Tsuji , Shota Sakai , Yoshio Tsuboi , Atsushi Kawamorita , Hiroaki Shimizu , Nobuo Araki , Takashi Hata , Hiroshi Ryu , Kazumasa Yamatani , Shinji Minami , Takahiro Maruta , Masaki Eto , Katsutoshi Takayama , Kazuo Hashikawa , Eiichiro Mabuchi , Yoshio Sakagami , Syoji Tsuchimoto , Jiro Kitayama , Kiyoshi Shirakawa , Haruki Takahashi , Syunro Uchinokura , Naohiro Osaka , Ichiro Imaf*cku , Toshiro Otsuka , Ryo Itabashi , Yuji Kujiraoka , Naohisa Miura , Koichi Nomura , Masahiro Kobari , Keizo Yasui , Susumu Kashino , Hiroto Murata , Kazuhiko Nozaki , Kosuke Yamash*ta , Katsumi Matsumoto , Yuji Shibata , Atsuo Aoyama , Yoshimasa Watanabe , Toru Eto , Susumu Mekaru , Tsuneo Honda , Masato Seike , Masahiro Kurisaka , Toshio Imaizumi , Kojiro Wada , Norihiro Suzuki , Atsuo Yoshino , Yukiko Hara , Shunya Takizawa , Kaoru Kamimoto , Hiroshi Iizuka , Yasuo Toma , Taro Komuro , Atsushi Sueyoshi , Yoshikazu Nakajima , Takayuki Sakaki , Hiroji Miyake , Masaru Idei , Tsutomu Hitotsumatsu , Shigehiro Nakahara , Masahiko Kawanishi , Takuji Kitaoka , Naoyuki Isobe , Masanobu Hokama , Toshihide Shibata , Kazuhito Tsuruta , Akihito Moriki , Masahiro Makino , Masafumi Otaki , Minoru Ajiki , Takaaki Yamazaki , Kiyohiro Houkin , Nobuyuki Yasui , Koichi Hirata , Hiroyuki Kato , Ichiro Suzuki , Takakazu Kawamata , Yoshikazu Uesaka , Kohei Yamash*ta , Yukiko Enomoto , Osamu Onodera , Masato Ikeda , Susumu Miyamoto , Manabu Sakaguchi , Hiroyuki Nakase , Yoshiki Yagita , Tetsuhiro Kitahara , Katsumi Irie , Tomohiko Kusuhara , Kazumasa Kawazoe , Shinji Nagahiro , Norikazu Kawada , Akiko Adachi , Toshihiro f*ckusako , Wataro Tsuruta , Naoko Fujimura , Takayuki Koizumi , Hiroyuki Tomimitsu , Shigeru Fujimoto , Tsukasa Tsuchiya , Hitoshi Aizawa , Nobutaka Ishizu , Shigeru Nogawa , Hideharu Furumoto , Toshihiro Ueda , Syogo Imae , Teiji Nakayama , Hiroki Namba , Jun Ochiai , Tomoko Yamana , Mitsuhito Mase , Noriyuki Matsukawa , Hisayoshi Niwa , Masatoshi Muramatsu , Yoshio Nakashima , Fuminori Iwamoto , Syunichi Yoneda , Kenji Hashimoto , Tatsuo Matsush*ta , Takenobu Kunieda , Osamu Masuo , Hirotaka Yamamoto , Naohisa Hosomi , Ryo Ogami , Koichi Kuramoto , Takahiro Matsumoto , Hirotsugu Shinozaki , Hiroshi Sugimori , Yoichiro Hashimoto , Hidenori Suzuki , Masahiro Waza , Yuki Kujyuro , Eiichi Kamei , Yasufumi Uchida , Masao Nagayama , Masahiko Hiroki , Hiroshi Sakura , Tatsuru Noujo , Yasutaka Tajima , Hajime Wada , Akira Hodozuka , Wataru Ide , Yasushi Shibata , Shinji Yamamoto , Masayuki Ishihara , Satsuki Miyata , Yoshiyuki Matsuoka , Yasuhisa Sakurai , Yoshiharu Miura , Takanori Yokota , Satoshi Iwabuchi , Wataro Tsuruta , Hirohiko Arimoto , Sumio Suda , Takashi Ohashi , Katsuhiro Kuroda , Takashi Matsuhisa , Kazutoshi Yokoyama , Eiichi Katada , Kenichiro Fujishiro , Akira Inukai , Yasushi Kobayashi , Hideki Sakai , Kenichi Yamamoto , Ken Asakura , Yuhei Yoshimoto , Yoshikazu Kusano , Ryoichi Takahashi , Sotaro Higashi , Cheho Park , Mitsutoshi Nakada , Makoto Matsui , Yoshinari Nagakane , Akira Yoshioka , Masahiro Makino , Kazuyoshi Yamaguchi , Yasushi Hagihara , Tomonori Yamada , Kenji Hashimoto , Toshiaki Fujita , Tetsuya Kumagai , Masayuki Sumida , Motohiro Morioka , Hiroaki Oboshi , Takanari Kitazono , Yukio Ando , Seiichiro Minato , Masahito Agawa , Takeshi Kono , Tomohiko Izumidani , Tetsuya Ueba , Hiroaki Takeuchi , Syuji Monden , Syoji Shiraishi , Hidehiko Syoji , Tatsuya Nakamura , Naoki Ikawa , Hiroshi Sugihara , Shinichi Toyonaga , Hiroyuki Kon , Yuji Kanamori , Hiroaki Tanaka , , , , , , , , , , 
We determined the associations of follow-up blood pressure (BP) after stroke as a time-dependent covariate with the risk of subsequent ischemic stroke, as well as those of BP levels with the difference in the impact of long-term clopidogrel or aspirin monotherapy versus additional cilostazol medication on secondary stroke prevention. In a sub-analysis of a randomized controlled trial (CSPS.com), patients between 8 and 180 days after stroke onset were randomly assigned to receive aspirin or clopidogrel alone, or a combination of cilostazol with aspirin or clopidogrel. The percent changes, differences, and raw values of follow-up BP were examined. The primary efficacy outcome was the first recurrence of ischemic stroke. In a total of 1657 patients (69.5 ± 9.3 years, female 29.1%) with median 1.5-year follow-up, ischemic stroke recurred in 74 patients. The adjusted hazard ratio for ischemic stroke of a 10% systolic BP (SBP) increase from baseline was 1.19 (95% CI 1.03–1.36), that of a 10 mmHg SBP increase was 1.14 (1.03–1.28), and that of SBP as the raw value with the baseline SBP as a fixed (time-independent) covariate was 1.14 (1.00–1.31). Such significant associations were not observed in diastolic BP-derived variables. The estimated adjusted hazard ratio curves for the outcome showed the benefit of dual therapy over a wide SBP range between ≈120 and ≈165 mmHg uniformly. Lower long-term SBP levels after ischemic stroke were associated with a lower risk of subsequent ischemic events. The efficacy of dual antiplatelet therapy including cilostazol for secondary stroke prevention was evident over a wide SBP range.
中文翻译：
中风后长期基于西洛他唑的双重抗血小板治疗期间的血压：CSPS.com 试验的事后分析
我们确定了中风后随访血压（BP）作为时间依赖性协变量与随后缺血性中风风险的关系，以及血压水平与长期氯吡格雷或阿司匹林单药治疗影响差异的关系。与额外的西洛他唑药物治疗中风二级预防的比较。在一项随机对照试验 (CSPS.com) 的亚组分析中，中风发作后 8 至 180 天的患者被随机分配接受单独服用阿司匹林或氯吡格雷，或联合服用西洛他唑与阿司匹林或氯吡格雷。检查了随访血压的百分比变化、差异和原始值。主要疗效结果是缺血性卒中的首次复发。在总共 1657 名患者（69.5±9.3 岁，女性 29.1%）的中位随访时间为 1.5 年的患者中，74 名患者复发了缺血性卒中。收缩压（SBP）较基线增加 10% 的缺血性卒中的调整后风险比为 1.19（95% CI 1.03-1.36），SBP 增加 10mmHg 的调整后风险比为 1.14（1.03-1.28），SBP 为以基线 SBP 作为固定（与时间无关）协变量的原始值为 1.14 (1.00–1.31)。在舒张压衍生变量中没有观察到这种显着的关联。结果的估计调整风险比曲线显示，双重治疗在约 120 至 约 165 mmHg 的宽 SBP 范围内均具有益处。缺血性中风后较低的长期收缩压水平与随后发生缺血性事件的风险较低相关。包括西洛他唑在内的双重抗血小板治疗对于卒中二级预防的疗效在较宽的 SBP 范围内是显而易见的。
更新日期：2024-07-09
