Blood Pressure Level and Variability During Long-Term Prasugrel or Clopidogrel Medication After Stroke: PRASTRO-I

Area of Science:

• Cardiology
• Neurology
• Pharmacology

Background:

• High blood pressure (hypertension) is a known risk factor for bleeding complications during antithrombotic treatment.
• The relationship between blood pressure variability and recurrent stroke risk in patients receiving thienopyridines, such as prasugrel, requires further investigation for effective secondary stroke prevention.

Purpose of the Study:

• To analyze the association between mean systolic blood pressure (SBP) levels and SBP variability with the risk of recurrent stroke and bleeding events.
• To compare these risks in patients treated with prasugrel versus clopidogrel for secondary stroke prevention.

Main Methods:

• Post hoc analysis of the randomized, double-blind PRASTRO-I trial involving 3747 patients with noncardioembolic stroke.
• Patients received either prasugrel 3.75 mg/day or clopidogrel 75 mg/day for 96-104 weeks.
• Risk assessment based on mean SBP levels and visit-to-visit SBP variability, comparing quartiles and successive variations.

Main Results:

• Increased mean SBP and higher SBP variability were significantly associated with higher risks of any stroke, ischemic stroke, hemorrhagic stroke, ischemic events, and bleeding events.
• Hazard ratios for stroke and bleeding events increased with higher mean SBP and greater SBP variability.
• No significant differences in event rates were observed between prasugrel and clopidogrel groups within SBP quartiles or variability groups.

Conclusions:

• Both elevated mean systolic blood pressure and high visit-to-visit SBP variability are significant risk factors for recurrent stroke and bleeding events in patients on long-term prasugrel or clopidogrel therapy.
• Effective hypertension control is essential for secondary stroke prevention, irrespective of the chosen antiplatelet agent.