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

Alberto Zanchetti, Lennart Hansson, Björn Dahlöf, Stevo Julius, Joël Ménard, Ingrid Warnold, Hans Wedel

Research output: Contribution to journalArticle

66 Citations (Scopus)

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 18790 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 ≥ 180 or diastolic pressure ≥ 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.

Original languageEnglish
Pages (from-to)2301-2307
Number of pages7
JournalJournal of Hypertension
Volume20
Issue number11
DOIs
Publication statusPublished - Nov 2002

Fingerprint

Aspirin
Hypertension
Creatinine
Myocardial Infarction
Hemorrhage
Placebos
Blood Pressure
Therapeutics
Random Allocation
Serum
Proportional Hazards Models
Cardiovascular Diseases

Keywords

  • Aspirin
  • Bleeding
  • Cardiovascular risk
  • Hypertension
  • Primary cardiovascular prevention

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology

Cite this

Zanchetti, A., Hansson, L., Dahlöf, B., Julius, S., Ménard, J., Warnold, I., & Wedel, H. (2002). Benefit and harm of low-dose aspirin in well-treated hypertensives at different baseline cardiovascular risk. Journal of Hypertension, 20(11), 2301-2307. https://doi.org/10.1097/00004872-200211000-00031

Benefit and harm of low-dose aspirin in well-treated hypertensives at different baseline cardiovascular risk. / Zanchetti, Alberto; Hansson, Lennart; Dahlöf, Björn; Julius, Stevo; Ménard, Joël; Warnold, Ingrid; Wedel, Hans.

In: Journal of Hypertension, Vol. 20, No. 11, 11.2002, p. 2301-2307.

Research output: Contribution to journalArticle

Zanchetti, A, Hansson, L, Dahlöf, B, Julius, S, Ménard, J, Warnold, I & Wedel, H 2002, 'Benefit and harm of low-dose aspirin in well-treated hypertensives at different baseline cardiovascular risk', Journal of Hypertension, vol. 20, no. 11, pp. 2301-2307. https://doi.org/10.1097/00004872-200211000-00031
Zanchetti, Alberto ; Hansson, Lennart ; Dahlöf, Björn ; Julius, Stevo ; Ménard, Joël ; Warnold, Ingrid ; Wedel, Hans. / Benefit and harm of low-dose aspirin in well-treated hypertensives at different baseline cardiovascular risk. In: Journal of Hypertension. 2002 ; Vol. 20, No. 11. pp. 2301-2307.
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