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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
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Hypertension With High-Risk Features in Cryptogenic Stroke: An Exploratory Analysis of the ARCADIA Randomized
Mohamed Ridha1, Raed Hailat1, Robert Stanton2
1Department of Neurology, The Ohio State University, Columbus.
JAMA Neurology
|April 20, 2026
Summary
High-risk hypertension modifies stroke treatment effectiveness. Apixaban reduced recurrent stroke risk compared to aspirin in patients without high-risk hypertension, but not in those with it.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Clinical Trials
Background:
- Secondary stroke prevention trials often show no difference between anticoagulation and antiplatelet therapy.
- This may be due to the inclusion of patients with hypertension-related cerebrovascular disease, complicating stroke mechanism classification.
Purpose of the Study:
- To investigate if high-risk hypertension modifies the treatment effect of anticoagulation versus antiplatelet therapy for secondary stroke prevention.
Main Methods:
- An exploratory analysis of the ARCADIA randomized clinical trial (NCT03192215) included 945 patients with cryptogenic stroke.
- Hypertension with high-risk features was defined by elevated blood pressure or left ventricular hypertrophy.
- Cox proportional hazards models assessed treatment interaction with hypertension status.
Main Results:
- 37.1% of patients had hypertension with high-risk features.
- Apixaban showed a reduced risk of recurrent ischemic stroke or systemic embolism compared to aspirin in patients without high-risk hypertension (HR, 0.43).
- No significant difference in treatment effect was observed in patients with high-risk hypertension (HR, 1.68).
Conclusions:
- High-risk hypertension appears to modify the effectiveness of antithrombotic treatments for secondary stroke prevention.
- Prior trials may have underestimated anticoagulation benefits by not excluding strokes due to hypertensive arteriopathy.
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