Benefit and harm of low-dose aspirin in well-treated hypertensives at different baseline cardiovascular risk.

Abstract

BACKGROUND:

The effects of aspirin in subjects without cardiovascular disease are controversial. In the intensively treated patients of the Hypertension Optimal Treatment (HOT) Study, randomization to low-dose aspirin (75 mg daily) versus placebo significantly reduced cardiovascular events (-15%) and myocardial infarction (-36%), but increased major bleedings (+65%). The present analyses of HOT Study data aim at identifying subgroups of hypertensives with different benefit-to-harm ratios from aspirin, in order to provide recommendations about the use of aspirin in hypertension.

METHODS:

The 18 790 hypertensive patients (aspirin 9399, placebo 9391; average treatment duration 3.8 years) were stratified for global cardiovascular risk and for individual risk factors. Subgroup-treatment interaction analyses (end points: cardiovascular events, myocardial infarction, major bleedings) were performed by a Cox proportional hazard model. Relative and absolute benefits and harms were calculated.

RESULTS:

Interaction analyses indicated that of all subgroups, only patients with serum creatinine > 1.3 mg/dl had a significantly greater reduction of cardiovascular events and myocardial infarction (-13 and -7/1000 patient-years), while risk of bleeding was not significantly different between subgroups. In addition to patients with higher creatinine, a favourable balance between benefit and harm of aspirin was found in subgroups of patients at higher global baseline risk and baseline systolic pressure > or = 180 or diastolic pressure > or = 107 mmHg.

CONCLUSIONS:

Low-dose aspirin should be recommended to well-treated hypertensive patients with even moderate increase in serum creatinine. Aspirin may also be recommended in well-treated hypertensives at higher global cardiovascular risk or higher initial blood pressures.

• Authors: Alberto Zanchetti, Lennart Hansson, Björn Dahlöf, Stevo Julius, Joël Ménard, Ingrid Warnold, Hans Wedel, HOT Study Group
• Journal: Journal of hypertension (J Hypertens) Vol. 20 Issue 11 Pg. 2301-7 (Nov 2002) ISSN: 0263-6352 [Print] Netherlands
• PMID: 12409970 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Inflammatory Agents, Non-Steroidal
• Aspirin

Topics

• Anti-Inflammatory Agents, Non-Steroidal (administration & dosage, adverse effects)
• Aspirin (administration & dosage, adverse effects)
• Blood Pressure (drug effects)
• Humans
• Hypertension (drug therapy, epidemiology)
• Myocardial Infarction (drug therapy, epidemiology)
• Risk Factors