Low-dose aspirin does not interfere with the blood pressure-lowering effects of antihypertensive therapy.
BACKGROUND
It has been reported that aspirin (ASA) may interfere with the blood pressure (BP)-lowering effect of various antihypertensive agents and attenuate the beneficial effects of angiotensin-converting enzyme (ACE) inhibitors in patients with congestive heart failure.


RESULTS
Data from the Hypertension Optimal Treatment (HOT) Study, in which 18 790 intensively treated hypertensive patients were randomized to either ASA 75 mg daily or placebo for 3.8 years (with a 15% reduction in cardiovascular events and a 36% reduction in myocardial infarction in ASA-treated patients), were reanalysed for the whole group of patients and for various subgroups with particular attention to the possible effects of ASA on BP and renal function. In ASA-treated and placebo-treated patients: (1) systolic blood pressure (SBP) and diastolic blood pressure (DBP) values achieved with antihypertensive treatment were superimposable, with clinically irrelevant differences; (2) these superimposable SBP and DBP were achieved with antihypertensive therapies, that were quantitatively and qualitatively similar, and (3) changes in serum creatinine and in estimated creatinine clearance and the number of patients developing renal dysfunction were also similar. Furthermore, the cardiovascular benefits of ASA were of the same magnitude in hypertensive patients receiving or not receiving ACE-inhibitors.


CONCLUSIONS
Even long-term, low-dose ASA does not interfere with the BP-lowering effect of antihypertensive agents, including combinations with ACE inhibitors, or with renal function. No negative interaction occurs between ACE inhibition and the cardiovascular benefits of small dose of ASA. Our conclusions cannot be extended to larger doses of ASA, or to patients with congestive heart failure.
Zanchetti
Alberto
A
Centro di Fisiologia Clinica e Ipertensione, Università di Milano, Ospedale Maggiore and Istituto Auxologico Italiano, Milano, Italy. zanchett@mailserver.unimi.it
Hansson
Lennart
L
Leonetti
Gastone
G
Rahn
Karl-Heinz
KH
Ruilope
Luis
L
Warnold
Ingrid
I
Wedel
Hans
H
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001241:Aspirin / Q000008:administration & dosage* / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects*; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D002319:Cardiovascular System / Q000187:drug effects; D003971:Diastole; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004347:Drug Interactions; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D007668:Kidney / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000494:pharmacology; D013599:Systole
D000959:Antihypertensive Agents; D010975:Platelet Aggregation Inhibitors; D001241:Aspirin