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Evidence summaries

ASA for Hypertension

Antiplatelet therapy with ASA for primary prevention in patients with elevated blood pressure may not reduce all-cause or cardiovascular mortality, may reduce the risk of cardiovascular events, and increases the risk of major bleeding events. Level of evidence: "C"

The quality of evidence is downgraded by study limitations (unclear allocation concealment and blinding), and by imprecise results.

A Cochrane review 1 [Abstract] of the role of antiplatelet therapy and anticoagulation in patients with elevated blood pressure (BP) included 6 studies with a total of 61 015 subjects; 4 placebo-controlled primary prevention studies (n=41 695) and 2 secondary prevention studies (n=19 320) with active comparators.

ASA versus placebo in primary prevention: No differences in all-cause mortality (OR 0.97, 95% CI 0.87 to 1.08; 3 studies, n=35 794) and cardiovascular mortality (OR 0.98, 95% CI 0.82 to 1.17; 3 studies, n=35 794) were observed. ASA reduced the risk of all non-fatal cardiovascular events (OR 0.63, 95% CI 0.45 to 0.87; 1 study, n=2 540) and the risk of all cardiovascular events (OR 0.86, 95% CI 0.77 to 0.96; 3 studies, n=35 794), and increased the risk of major bleeding events (OR 1.77, 95% CI 1.34 to 2.32; 2 studies, n=21 330).

Primary/Secondary Keywords