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Background and Purpose: Intracranial hemorrhage rates are higher in Asians than non-Asians, especially in patients receiving warfarin. This randomized evaluation of long-term anticoagulation therapy subgroup analysis assessed dabigatran etexilate (DE) and warfarin effects on stroke and bleeding rates in patients from Asian and non-Asian countries., Methods: There were 2782 patients (15%) from 10 Asian countries and 15 331 patients from 34 non-Asian countries. A Cox regression model, with terms for treatment, region, and their interaction was used., Results: Rates of stroke or systemic embolism in Asians were 3.06% per year on warfarin, 2.50% per year on DE 110 mg BID (DE 110), and 1.39% per year on DE 150 mg BID (DE 150); in non-Asians, the rates were 1.48%, 1.37%, and 1.06% per year with no significant treatment-by-region interactions. Hemorrhagic stroke on warfarin occurred more often in Asians than non-Asians (hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.3-4.7; P=0.007), with significant reductions for DE compared with warfarin in both Asian (DE 110 versus warfarin HR, 0.15; 95% CI, 0.03-0.66 and DE 150 versus warfarin HR, 0.22; 95% CI, 0.06-0.77) and non-Asian (DE 110 versus warfarin HR, 0.37; 95% CI, 0.19-0.72 and DE 150 versus warfarin HR, 0.28; 95% CI, 0.13-0.58) patients. Major bleeding rates in Asians were significantly lower on DE (both doses) than warfarin (warfarin 3.82% per year, DE 110 2.22% per year, and DE 150 2.17% per year)., Conclusions: Hemorrhagic stroke rates were higher on warfarin in Asians versus non-Asians, despite similar blood pressure, younger age, and lower international normalized ratio values. Hemorrhagic strokes were significantly reduced by DE in both Asians and non-Asians. DE benefits were consistent across Asian and non-Asian subgroups., Clinical Trial Registration Url: http://www.clinicaltrials.gov. Unique identifier: NCT00262600.

Stroke results in substantial morbidity and mortality globally. Asia-Pacific countries bear a disproportionate share of the burden of stroke, a burden that will grow as their populations' life expectancies rise. Hypertension is the single most important reversible risk factor for stroke, and effective measures to reduce blood pressure contribute significantly to reducing the incidence of stroke. The Asia-Pacific Consensus Conference on Stroke Prevention in Hypertensive Patients assembled leading experts from the region to reach an actionable consensus aimed at reducing stroke-induced morbidity and mortality in Asia through the evidence-based treatment of hypertension. The discussions of the group focused on how best to improve blood pressure control, how to promote lifestyle changes at the population level, and how to reduce the clinical and health system barriers and other challenges facing developing and low-income countries. The experts concluded that physicians must place an increased priority on reducing their patients' risk of stroke and recognise that all hypertensive patients are at greater risk of having a stroke compared with nonhypertensive individuals. They advocated that physicians must educate hypertensive patients about the risk of stroke, promote lifestyle modification to all patients diagnosed with hypertension, and prescribe rigorous antihypertensive treatment to get patients to recommended blood pressure goals.

Objective: To assess the consistency of the benefits of blood pressure lowering on secondary stroke risk by age, sex and geographic region of recruitment., Design: Randomized, placebo-controlled trial. Participants were randomized to the angiotensin-converting enzyme (ACE) inhibitor perindopril (plus the diuretic indapamide if not indicated or contraindicated) or to placebo(s) over a mean follow-up of 3.9 years. Main analyses used Cox proportional hazards models on an intention-to-treat basis. Subgroup results were standardized for the proportion (42%) taking single-drug therapy., Setting: A total of 172 centres in Asia, Australia, New Zealand and Europe., Participants: Patients (n = 6105) with a history of stroke or transient ischaemic attack, of whom 50% were aged over 65 years at baseline, 30% were women and 39% were from Asia., Main Outcome Measures: Stroke, coronary heart disease and major vascular events., Results: Overall, treatment reduced stroke by 28% [95% confidence interval (CI) 17-38%] and major vascular events by 26% (16-44%), with separately significant reductions across subgroups defined by age (< or > or = 65 years), sex and region (Asia or not). Treatment was safe and well tolerated, and the absolute benefits were large; 5 years' treatment would be expected to avert at least one major vascular event among every 20 patients in all age, sex and region subgroups. There was some evidence of particularly large benefits among younger participants and those from Asia., Conclusions: Blood pressure lowering reduces secondary stroke risk, with large absolute benefits across groups defined by age, sex and geographic region.