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Thank you for visiting nature. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser or turn off compatibility mode in Internet Explorer. In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript. A Comment to this article was published on 08 August We determined the associations of follow-up blood pressure BP after stroke as a time-dependent covariate with the risk of subsequent ischemic stroke, as well as those of BP levels with the difference in the impact of long-term clopidogrel or aspirin monotherapy versus additional cilostazol medication on secondary stroke prevention.

In a sub-analysis of a randomized controlled trial CSPS. The percent changes, differences, and raw values of follow-up BP were examined. The primary efficacy outcome was the first recurrence of ischemic stroke. In a total of patients Such significant associations were not observed in diastolic BP-derived variables. Lower long-term SBP levels after ischemic stroke were associated with a lower risk of subsequent ischemic events. The efficacy of dual antiplatelet therapy including cilostazol for secondary stroke prevention was evident over a wide SBP range.

Long-term treatment with cilostazol, a phosphodiesterase 3 inhibitor, coupled with aspirin or clopidogrel was shown to halve the risk of recurrent ischemic stroke and have a similar risk of severe or life-threatening bleeding compared to aspirin or clopidogrel alone in patients at high risk for recurrent noncardioembolic ischemic stroke in a randomized, controlled trial, the Cilostazol Stroke Prevention Study for Antiplatelet Combination CSPS. Cilostazol is known to have a lower risk of bleeding than the other antiplatelet agents [ 2 , 3 ], and the result of the safety outcome was within the expectations of the trial investigators.

In contrast, the strong efficacy of the dual antiplatelet therapy DAPT with half the risk of recurrent ischemic stroke exceeded our assumptions to some extent. The possible clinical conditions causing such clear efficacy need clarification. The post-stroke blood pressure BP level is predictive of recurrent stroke risk [ 4 , 5 , 6 , 7 ]. Several guidelines recommend intensive BP lowering for chronic stroke to prevent recurrent stroke [ 8 , 9 , 10 ].