Effect of history of hypertension on efficacy of clopidogrel-aspirin in ischemic stroke

BackgroundPatients with different hypertension status could potentially respond differently to the treatment of clopidogrel-aspirin owing to thrombosis, antiplatelet resistance, and platelet reactivity.AimsTo examine the efficacy and safety of clopidogrel-aspirin in patients with mild ischemic stroke or high-risk TIA according to different hypertension status.MethodsIn the Intensive Statin and Antiplatelet Therapy for Acute High-Risk Intracranial or Extracranial Atherosclerosis (INSPIRES) trial, patients were randomized to either clopidogrel-aspirin or aspirin group. The primary outcome was any new ischemic or hemorrhagic stroke within 90 days. Hypertension status was classified into two categories based on medical history: patients with or without hypertension.ResultsAmong 6100 patients with complete data of hypertension status, 3915(64.2%) were men. Clopidogrel-aspirin compared with aspirin was associated with reduced incidence of new stroke in patients without hypertension (HR: 0.62 [95% CI: 0.44-0.86], P=0.004), but not in patients with hypertension (HR: 0.87 [95% CI: 0.71-1.07], P=0.18; P=0.085 for interaction).ConclusionsIn this study, patients without hypertension may have more benefit from receiving treatment with clopidogrel-aspirin than those with hypertension. This finding can be used as an enrichment strategy in the future secondary stroke prevention randomized clinical trials of dual antiplatelet therapy.Trial Registration: The INSPIRES trial was registered at http://www. clinicaltrials.gov (unique identifier: NCT03635749).