Blood pressure during long-term cilostazol-based dual antiplatelet therapy after stroke: a post hoc analysis of the CSPS.com trial

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2024年7月9日

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Kazunori Toyoda,
Masatoshi Koga,
Kenta Tanaka,
Shinichiro Uchiyama,
Hisato Sunami,
Katsuhiro Omae,
Kazumi Kimura,
Haruhiko Hoshino,
Mayumi Fukuda-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,
Yoshitaka 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 Fukushima,
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,
Toshitaka 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 Imafuku,
Toshiro Otsuka,
Ryo Itabashi,
Yuji Kujiraoka,
Naohisa Miura,
Koichi Nomura,
Masahiro Kobari,
Keizo Yasui,
Susumu Kashino,
Hiroto Murata,
Kazuhiko Nozaki,
Kosuke Yamashita,
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 Yamashita,
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 Fukusako,
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 Matsushita,
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

摘要

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.