Abstract 2875: Effect of Mean, Maximum, and Variation of Blood Pressure in Patients with Ischemic Stroke during Antiplatelet Therapy
Background: The Japanese Aggrenox Stroke Prevention vs. Aspirin Programme (JASAP) study was a double-blind, randomized clinical trial to compare the efficacy and safety of extended-release dipyridamole plus aspirin versus aspirin alone over 1 year in 1294 patients with non-cardioembolic ischemic stroke. We analyzed the effect of mean and maximum as well as variation of blood pressure on recurrence of ischemic stroke and intracranial hemorrhage (ICH) in patients enrolled in the JASAP study.
Methods: We analyzed individual blood pressure at all visits including baseline, weeks 0, 1 and then every 4 weeks to a maximum of 124 weeks to compare mean and maximum systolic and diastolic blood pressure (BP) as well as standard deviation (SD) of variations of individual BP measurements.
Results: Mean Systolic BP (SBP) for the last 3 months was significantly higher (140.6 mmHg vs. 135.4 mmHg, p = 0.002) in patients with than without ischemic stroke, while SD of variation of individual SBP measurements was significantly larger in patients with than without ICH (12.0 mmHg vs. 9.2 mmHg, p = 0.025). Mean diastolic BP (DBP) at the last visit was significantly higher in patients with than without ICH (84.0 mmHg vs. 78.1 mmHg, p = 0.012). Although ICH was tended to be more frequent in the highest tertile than in the lowest tertile of SD of variation of SBP (HR 1.513, 95% CI 0.298-2.286, p = 0.090) and of maximum SBP (HR 1.637, 95% CI 0.982-2.728, p = 0.059), such trend was not seen in ischemic stroke of SD of variation of SBP (HR 1.034, 95% CI 0.792-1.351, p = 0.804) and of maximum SBP (HR 0.925, 95% CI 0.699-1.225, p = 0.588)
Conclusion: Despite of small sample size and different treatment arms, these results indicate that mean, maximum, and variation of SBP and DBP may affect differently on the occurrence of ischemic and hemorrhagic strokes in patients on antiplatelet agents.
- © 2012 by American Heart Association, Inc.