Effects of a benidipine-based combination therapy on the risk of stroke according to stroke subtype: the COPE trial
Effects of a benidipine-based combination therapy on the risk of stroke according to stroke subtype: the COPE trial
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DOI：
10.1038/hr.2013.100
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发表时间：
2013-12-01
影响因子：
5.4
通讯作者：
Matsuzaki, Masunori
中科院分区：
文献类型：
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作者：
Umemoto, Seiji;Ogihara, Toshio;Matsuzaki, Masunori
联合治疗高血压以预防心血管事件（科普）试验比较了二氢吡啶类T/L型钙通道阻滞剂贝尼地平与血管紧张素受体阻滞剂（ARB）、β受体阻滞剂（BB）或噻嗪类利尿剂（TD）联合使用时的治疗。结果表明，贝尼地平与BB联合使用在降低卒中风险方面的益处低于贝尼地平-TD联合使用（风险比（HR）：2.31，P = 0.0109）。我们进一步评估了三种贝尼地平为基础的方案对不同亚型脑卒中的治疗效果。科普试验是一项采用PROBE设计的、由患者发起的多中心研究。房颤或房扑患者从研究中排除。所有卒中事件均按照急性卒中治疗试验（吐司）标准进行亚分类。卒中的总发病率为4.7/1000人年，出血性卒中为1.6/1000人年，缺血性卒中为2.5/1000人年。腔隙性卒中的发病率为1.1/1000人-年，大动脉卒中为0.6/1000人-年，心源性栓塞性卒中为0.3/1000人-年，未知缺血类型为0.6/1000人-年，短暂性脑缺血发作为0.6/1000人-年。虽然三个治疗组之间观察到的卒中亚型差异不大，但贝尼地平-BB方案的所有类型卒中、出血性卒中和缺血性卒中发生率的多校正HR均显著高于贝尼地平-TD方案。贝尼地平-ARB方案出血性和缺血性卒中的发生率与其他两种治疗方案相比无差异。这一预先设定的亚组分析表明，贝尼地平TD方案的降压治疗可能有利于高血压患者预防出血性和缺血性卒中。
The Combination Therapy of Hypertension to Prevent Cardiovascular Events (COPE) trial compared the dihydropyridine T/L-type calcium channel blocker benidipine-based therapies when combined with an angiotensin receptor blocker (ARB), a beta-blocker (BB) or a thiazide diuretic (TD). The results suggested that benidipine combined with a BB appeared to be less beneficial in reducing the risk of stroke compared with the benidipine-TD combination (hazard ratio (HR): 2.31, P = 0.0109). We further evaluated the treatment effects on different stroke subtypes among the three benidipine-based regimens. The COPE trial was an investigator-initiated, multicenter study with PROBE design. Patients with atrial fibrillation or flutter were excluded from the study. All stroke events were subclassified with the Trial of Org 10 172 in Acute Stroke Treatment (TOAST) criteria. The total incidence of stroke was 4.7, hemorrhagic stroke was 1.6 and ischemic stroke was 2.5 per 1000 person-years. The incidence of lacunar stroke was 1.1, large-artery stroke was 0.6, cardioembolic stroke was 0.3, unknown ischemic type was 0.6 and transient ischemic attack was 0.6 per 1000 person-years. Although few differences in stroke subtypes were observed among the three treatment groups, multi-adjusted HRs for the incidence rates of all types of stroke, hemorrhagic stroke and ischemic stroke were significantly higher with the benidipine-BB regimen than with the benidipine-TD regimen. The incidence of both hemorrhagic and ischemic stroke in the benidipine-ARB regimen was not different compared with the other two treatment regimens. This prespecified sub-analysis suggested that a blood pressure-lowering therapy with a benidipine-TD regimen might be beneficial for hypertensive patients to prevent both hemorrhagic and ischemic stroke.