Abstract 10628: Effects of a Benidipine-Based Blood Pressure-Lowering Regimen on the Risk of Stroke According to Stroke Subtype: The COPE Trial
Background and Purpose-The Combination Therapy of Hypertension to Prevent Cardiovascular Events (COPE) Trial demonstrated that therapies based on the dihydropyridine L/T-type calcium channel blocker benidipine combined with an angiotensin receptor blocker (ARB), a β-blocker (BB), or a thiazide diuretic (TD) were similarly effective in preventing cardiovascular events and achieving the target blood pressure (BP; <140/90 mmHg). However, second analyses suggested that benidipine combined with a BB appeared to be less beneficial in reducing the risk of stroke compared with the benidipine-TD combination (HR: 2.31, P=0.01). Thus, we further evaluated the treatment effects of different stroke subtypes among the three benidipine-based regimens.
Methods-The COPE Trial was an investigator-initiated multi-center study with PROBE design in 3293 hypertensive patients who did not achieve the target BP with benidipine 4mg/day. Occurrence of previous cardiovascular events and need for anti-platelet/anti-coagulation therapy were similar among the three groups. Patients with atrial fibrillation or flutter were excluded from the study. All stroke events were subclassified with the TOAST criteria.
Results-During a median follow-up of 3.6 years, the total incidence of stroke was 4.7; hemorrhagic stroke 1.6; and ischemic stroke 2.5 per 1000 person-years. The incidence of lacunar stroke was 1.1; large-artery stroke 0.6; cardioembolic stroke 0.3; unknown ischemic type 0.6; and transient ischemic attack 0.6 per 1000 person-years. Although little differences in stroke subtypes were observed among the three treatment groups, the incidence of hemorrhagic stroke was higher with the benidipine-BB regimen than with the benidipine-TD regimen (HR: 4.60, P=0.04). The incidence of ischemic stroke was also higher with the benidipine-BB regimen than with the benidipine-TD regimen (HR: 2.56, P=0.04). The incidence of both hemorrhagic stroke and ischemic stroke in the benidipine-ARB regimen was not different compared to the other two treatment regimens.
Conclusions-This subanalysis of the COPE Trial suggests that BP-lowering therapy with a benidipine-TD regimen may be beneficial for hypertensive patients to prevent both hemorrhagic and ischemic stroke.
- © 2012 by American Heart Association, Inc.