Abstract 12906: Impact of Blood Pressure Control in Type 2 Diabetes Patients in Relation to Aspirin Therapy: Insight From the JPAD Trial
Background: The Japanese primary prevention of atherosclerosis with aspirin for diabetes (JPAD) trial was undertaken to examine the efficacy of aspirin therapy. Multicenter, prospective, randomized, open label, blinded, end-point trial conducted from 2002 through 2008, which enrolled 2539 patients and had a median follow-up of 4.37 years.
Methods: In the subgroup analysis of the JPAD trial, we divided the patients into uncontrolled blood pressure (BP) group (systolic BP≥140 mmHg or diastolic BP≥90 mmHg or both) or controlled BP group according to baseline BP. We also divided the patients into uncontrolled BP group (systolic BP≥130 mmHg or diastolic BP≥80 mmHg or both) or controlled BP group. We examined whether there was any difference in the effect of aspirin therapy according to the level of BP control.
Results: When the JPAD patients were divided into two groups by BP 140/90 mmHg, the incidence of stroke events was significantly higher in the uncontrolled BP group than in the controlled BP group (hazard ratio, 2.18; 95% confidence interval, 1.37–3.50; log-rank P=.0008), but not in the incidence of the coronary events between the two groups (log-rank P=.9751). In the aspirin user, there was no significant difference in the incidence of stroke events between the uncontrolled BP group and the controlled BP group (Figure). In the nonaspirin user, there was a significant difference in the incidence of stroke events between the two groups (Figure). When the patients were divided into two groups by BP 130/80 mmHg, there was no significant difference in the incidence of stroke events between the two groups even in the nonaspirin user (Figure). Thus, the subgroup analysis of the JPAD trial shows an evidence that inhibition of stroke events by aspirin therapy is stronger in poorly BP controlled patients than in well BP controlled patients.
Conclusions: Aspirin therapy is more useful in diabetes patients with higher BP and control of BP <130/80 mmHg in diabetes patients may be a good target.
- © 2010 by American Heart Association, Inc.