机构：[1]Department of Cardiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China诊疗科室心脏及大血管病中心首都医科大学附属天坛医院[2]Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China重点科室诊疗科室神经病学中心神经病学中心首都医科大学附属天坛医院[3]China National Clinical Research Center for Neurological Diseases, Beijing, China[4]Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China[5]Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
Mean arterial pressure (MAP) is the strongest predictor of stroke. The combination of clopidogrel and aspirin within 24 hours after onset has been suggested by the Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events (CHANCE) study to be superior to aspirin alone. However, it is not clear whether poststroke blood pressure has an influence on the efficacy and safety of dual antiplatelet treatment. We have performed a post hoc analysis from the CHANCE trial. Patients were stratified into three groups based on MAP levels. Among patients with MAP <102 mm Hg, there was no significant difference in stroke recurrence between the clopidogrel-aspirin group and the aspirin group (7.7% vs 7.5%; hazard ratio [HR], 1.03; 95% confidence interval [CI], 0.73-1.45). However, compared to aspirin treatment, the clopidogrel-aspirin dual treatment was more effective at reducing the risk of stroke in patients with MAP >= 113 mm Hg (6.9% vs 12.3%, HR, 0.55; 95% CI, 0.39-0.78) or 102-113 mm Hg (9.5% vs 14.9%, HR, 0.62; 95% CI, 0.48-0.81). There was a significant interaction between MAP and antiplatelet therapy as it relates to stroke recurrence (P for interaction = 0.037), and a similar result was found for combined vascular events (P for interaction = 0.027). In conclusion, dual antiplatelet therapy may be more effective at reducing combined vascular events in patients with higher MAP after minor stroke or transient ischemic attack.
基金：
Ministry of Science and Technology of the People's Republic of ChinaMinistry of Science and Technology, China [2011BAI08B01, 2013BAI09B03]; Beijing Municipal Administration of Hospitals' Youth Program [QML2015 0504]; Science and Technology Agency of Henan Province [152102310059]
第一作者机构：[1]Department of Cardiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
通讯作者：
通讯机构：[1]Department of Cardiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China[2]Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China[3]China National Clinical Research Center for Neurological Diseases, Beijing, China[4]Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China[5]Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China[*1]Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Dongcheng District, Beijing, China.[*2]Department of Cardiology, Beijing Tiantan Hospital, Capital Medical University, Dongcheng District, Beijing, China.
推荐引用方式(GB/T 7714)：
Ma Yan,Liu Ying,Xu Jie,et al.The influence of mean arterial pressure on the efficacy and safety of dual antiplatelet therapy in minor stroke or transient ischemic attack patients[J].JOURNAL OF CLINICAL HYPERTENSION.2019,21(5):598-604.doi:10.1111/jch.13527.
APA：
Ma, Yan,Liu, Ying,Xu, Jie,Wang, Yilong,Du, Fenghe&Wang, Yongjun.(2019).The influence of mean arterial pressure on the efficacy and safety of dual antiplatelet therapy in minor stroke or transient ischemic attack patients.JOURNAL OF CLINICAL HYPERTENSION,21,(5)
MLA：
Ma, Yan,et al."The influence of mean arterial pressure on the efficacy and safety of dual antiplatelet therapy in minor stroke or transient ischemic attack patients".JOURNAL OF CLINICAL HYPERTENSION 21..5(2019):598-604
