ASA for hypertension

Evidence Summaries

Level of Evidence = C
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.

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

A Cochrane review 1 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).


1. Shantsila E, Koziel-Siolkowska M, Lip GY. Antiplatelet agents and anticoagulants for hypertension. Cochrane Database Syst Rev 2022;(7):CD003186.  [PMID:35900898].

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