title: 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.affiliation: Centro di Fisiologia Clinica e Ipertensione, University of Milan, Ospedale Maggiore and Istituto Auxologico Italiano, Milan, Italy. zanchett@mailserver.unimi.it
authors.forename: Alberto
authors.initials: A
authors.lastname: Zanchetti
authors.forename: Lennart
authors.initials: L
authors.lastname: Hansson
authors.forename: Björn
authors.initials: B
authors.lastname: Dahlöf
authors.forename: Stevo
authors.initials: S
authors.lastname: Julius
authors.forename: Joël
authors.initials: J
authors.lastname: Ménard
authors.forename: Ingrid
authors.initials: I
authors.lastname: Warnold
authors.forename: Hans
authors.initials: H
authors.lastname: Wedel
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage* / Q000009:adverse effects*; D001241:Aspirin / Q000008:administration & dosage* / Q000009:adverse effects*; D001794:Blood Pressure / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology; D009203:Myocardial Infarction / Q000188:drug therapy / Q000453:epidemiology; D012307:Risk Factors
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D001241:Aspirin