Evaluation of Systolic Blood Pressure, Use of Aspirin and Clopidogrel, and Stroke Recurrence in the Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke Trial

Key Points Question Among patients with transient ischemic attack and stroke, what is the association between blood pressure and dual antiplatelet therapy and rates of secondary stroke within 90 days after the original ischemic event? Findings In a post hoc analysis of 4781 patients in the POINT trial, having a baseline systolic blood pressure less than 140 mm Hg was associated with dual antiplatelet therapy significantly reducing the risk of ischemic stroke recurrence by 64% compared with aspirin alone, whereas having a baseline systolic blood pressure greater than or equal to 140 mm Hg was not associated with benefit for dual antiplatelet therapy. Meaning Additional research is needed to replicate these findings and potentially test whether mild blood pressure reduction combined with dual antiplatelet therapy started within 12 hours of stroke onset lowers early risk of stroke recurrence.
This cohort study investigates whether dual antiplatelet therapy is associated with stroke recurrence among patients with or without elevated baseline systolic blood pressure in the Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke (POINT) trial.
Importance Elevated systolic blood pressure (SBP) after acute ischemic stroke and transient ischemic attack (TIA) is associated with future stroke risk. Objective To explore the association of dual antiplatelet therapy (DAPT) with stroke recurrence among patients with acute ischemic stroke and TIA with or without elevated baseline SBP. Design, Setting, and Participants This cohort study performed a post hoc subgroup analysis of the Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke (POINT) trial, which was a multicenter trial conducted from 2010 to 2018 at 269 sites in 10 countries in North America, Europe, Australia, and New Zealand. Patients enrolled in POINT with available blood pressure and outcome data were included in this cohort. Statistical analysis was performed from November 2020 to January 2021. Exposures Baseline SBP less than 140 mm Hg vs greater than or equal to 140 mm Hg and the interaction term of SBP (