Acetylsalicylic acid ( ASA ) did not reduce stroke or ‘ all cardiovascular events ’ compared to placebo in primary prevention patients with elevated BP and no prior cardiovascular disease .
To conclude for primary prevention in patients with elevated BP , antiplatelet therapy with ASA can not be recommended since the magnitude of benefit , a reduction in myocardial infa rct ion , is negated by a harm of similar magnitude , an increase in major haemorrhage .
Although elevated systemic blood pressure ( BP ) results in high intravascular pressure , the main complications of hypertension are related to thrombosis rather than haemorrhage .
It therefore seemed plausible that use of antithrombotic therapy may be useful in preventing thrombosis-related complications of elevated BP .
The objectives were to conduct a systematic review of the role of antiplatelet therapy and anticoagulation in patients with BP , to address the following hypotheses : ( i ) antiplatelet agents reduce total deaths and /or major thrombotic events when compared to placebo or other active treatment ; and ( ii ) oral anticoagulants reduce total deaths and /or major thromboembolic events when compared to placebo or other active treatment .
Final report on the aspirin component of the ongoing Physicians' Health Study.
The Physicians ' Health Study is a r and omized , double-blind , placebo-controlled trial design ed to determine whether low-dose aspirin ( 325 mg every other day ) decreases cardiovascular mortality and whether beta carotene reduces the incidence of cancer . The aspirin component was terminated earlier than scheduled , and the preliminary findings were published . We now present detailed analyses of the cardiovascular component for 22,071 participants , at an average follow-up time of 60.2 months . There was a 44 percent reduction in the risk of myocardial infa rct ion ( relative risk , 0.56 ; 95 percent confidence interval , 0.45 to 0.70 ; P less than 0.00001 ) in the aspirin group ( 254.8 per 100,000 per year as compared with 439.7 in the placebo group ) . A slightly increased risk of stroke among those taking aspirin was not statistically significant ; this trend was observed primarily in the subgroup with hemorrhagic stroke ( relative risk , 2.14 ; 95 percent confidence interval , 0.96 to 4.77 ; P = 0.06 ) . No reduction in mortality from all cardiovascular causes was associated with aspirin ( relative risk , 0.96 ; 95 percent confidence interval , 0.60 to 1.54 ) . Further analyses showed that the reduction in the risk of myocardial infa rct ion was apparent only among those who were 50 years of age and older . The benefit was present at all levels of cholesterol , but appeared greatest at low levels . The relative risk of ulcer in the aspirin group was 1.22 ( 169 in the aspirin group as compared with 138 in the placebo group ; 95 percent confidence interval , 0.98 to 1.53 ; P = 0.08 ) , and the relative risk of requiring a blood transfusion was 1.71 . This trial of aspirin for the primary prevention of cardiovascular disease demonstrates a conclusive reduction in the risk of myocardial infa rct ion , but the evidence concerning stroke and total cardiovascular deaths remains inconclusive because of the inadequate numbers of physicians with these end points
Acetylsalicylic acid ( ASA ) did not reduce stroke or ‘ all cardiovascular events ’ compared to placebo in primary prevention patients with elevated BP and no prior cardiovascular disease .
To conclude for primary prevention in patients with elevated BP , antiplatelet therapy with ASA can not be recommended since the magnitude of benefit , a reduction in myocardial infa rct ion , is negated by a harm of similar magnitude , an increase in major haemorrhage .
Although elevated systemic blood pressure ( BP ) results in high intravascular pressure , the main complications of hypertension are related to thrombosis rather than haemorrhage .
It therefore seemed plausible that use of antithrombotic therapy may be useful in preventing thrombosis-related complications of elevated BP .
The objectives were to conduct a systematic review of the role of antiplatelet therapy and anticoagulation in patients with BP , to address the following hypotheses : ( i ) antiplatelet agents reduce total deaths and /or major thrombotic events when compared to placebo or other active treatment ; and ( ii ) oral anticoagulants reduce total deaths and /or major thromboembolic events when compared to placebo or other active treatment .