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Background: Owing to the differential propensity for bleeding and ischemic events with response to antiplatelet therapy, the safety and effectiveness of potent P2Y12 inhibitor ticagrelor in East Asian populations remain uncertain. Methods: In this multicenter trial, 800 Korean patients hospitalized for acute coronary syndromes with or without ST elevation and intended for invasive management were randomly assigned to receive, in a 1:1 ratio, ticagrelor (180 mg loading dose, 90 mg twice daily thereafter) or clopidogrel (600 mg loading dose, 75 mg daily thereafter). The primary safety outcome was clinically significant bleeding (a composite of major bleeding or minor bleeding according to PLATO (Platelet Inhibition and Patient Outcomes) criteria at 12 months. Results: At 12 months, the incidence of clinically significant bleeding was significantly higher in the ticagrelor group than in the clopidogrel group (11.7% [45/400] vs 5.3% [21/400]; hazard ratio [HR], 2.26; 95% confidence interval [CI], 1.34 to 3.79; P =0.002). The incidences of major bleeding (7.5% [29/400] vs 4.1% [16/400], P =0.04) and fatal bleeding (1% [4/400] vs 0%, P =0.04) were also higher in the ticagrelor group. The incidence of death from cardiovascular causes, myocardial infarction, or stroke was not significantly different between the ticagrelor group and the clopidogrel group (9.2% [36/400] vs 5.8% [23/400]; HR, 1.62; 95% CI, 0.96 to 2.74; P =0.07). Overall safety and effectiveness findings were similar with the use of several different analytic methods and in multiple subgroups. Conclusions: In Korean acute coronary syndrome patients intended to receive early invasive management, standard-dose ticagrelor as compared with clopidogrel was associated with a higher incidence of clinically significant bleeding. The numerically higher incidence of ischemic events should be interpreted with caution, given the present trial was underpowered to draw any conclusion regarding efficacy. Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02094963.

Introduction: The major hypertension guidelines suggest methods for diagnosing hypertension by measuring the 24-hour ambulatory blood pressure (ABP) or home blood pressure (HBP) if hypertension is suspected. Hypothesis: there is no consensus of cut off values for HBP as the criterion for hypertension and also optimal duration of home blood pressure measurement (HBPM). Methods: 319 suspected hypertension patients (systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg, average value of three times measurements of blood pressure in the office) were included in four university hospital. The blood pressure (BP) measurement taken by patients in his/her home with HBPM device (Watch BP Home, Microlife, Swiss) and measured three times with one minute interval at morning and evening for 7 days. The 24-hour ambulatory blood pressure measurement (ABPM) was performed by Mobil-O-Graph (IEM. GmbH, Germany). The device was set to obtain BP readings at 30-minute intervals during the day and night. The definition of hypertension was as follows, SBP ≥135 mmHg or DBP ≥85 mmHg for HBPM and SBP ≥130 mmHg or DBP ≥85 mmHg for ABPM. For the analysis for diagnostic accuracy of HBPM, we used ABPM as a reference standard for the diagnosis of hypertension. Results: We decided to exclude 53 patients due to dropout or lack of valid BP measurement (valid leadings Conclusions: A 5-day HBPM is enough for the diagnosis of hypertension considering ABPM as a reference. The cut off value of hypertension in HBPM is same to the current guideline values (135/85 mmHg) in this study. HBPM is an effective and available method for the diagnosis of hypertension in suspected hypertensive patients.

We thank Dr Sardar and colleagues for their interest in our recent article1 and appreciate the opportunity to reply. We agree that medication adherence is associated with clinical outcomes and remains an important issue in clinical drug trials. Unfortunately, there are no definite methods for assessing adherence to medications. In our study, pill count was used to determine medication adherence, and pharmacy data were electronically checked by medical insurance system. Medical adherence in this type of study is considered generally poor. Even in the Platelet Inhibition and Patient Outcome (PLATO) trial, medical adherence was ≈80%.2 In this context, we believe that medical adherence in our study seems to be acceptable. Time from index procedure to randomization was rather variable, but most patients were enrolled between 12 …