Acetylsalicylic acid ( ASA ) did not reduce stroke or ' all cardiovascular events ' compared to placebo in primary prevention patients with elevated blood pressure and no prior cardiovascular disease .
Antiplatelet therapy with ASA for primary prevention in patients with elevated blood pressure provides a benefit , reduction in myocardial infa rct ion , which is negated by a harm of similar magnitude , increase in major haemorrhage .
The benefit of antiplatelet therapy for secondary prevention in patients with elevated blood pressure is many times greater than the harm .
Benefit has not been demonstrated for warfarin therapy alone or in combination with aspirin in patients with elevated blood pressure .
BACKGROUND Elevated systemic blood pressure results in high intravascular pressure but the main complications , coronary heart disease ( CHD ) , ischaemic strokes and peripheral vascular disease ( PVD ) , are related to thrombosis rather than haemorrhage .
Some complications related to elevated blood pressure , heart failure or atrial fibrillation , are themselves associated with stroke and thromboembolism .
Therefore it is important to investigate if antithrombotic therapy may be useful in preventing thrombosis-related complications in patients with elevated blood pressure .
OBJECTIVES To conduct a systematic review of the role of antiplatelet therapy and anticoagulation in patients with high blood pressure , including those with elevations in both systolic and diastolic blood pressure , isolated elevations of either systolic or diastolic blood pressure , 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 .
Ticlopidine , clopidogrel and newer antiplatelet agents such as prasugrel and ticagrelor have not been sufficiently evaluated in patients with high blood pressure .
Amlodipine and haemodynamic effects of cyclo-oxygenase inhibition.
1 . The haemodynamic effects of calcium antagonists could depend at least in part on the activity of vasoactive prostanoids . 2 . We set out to study the effect of the cyclo-oxygenase inhibitor ibuprofen , 400 mg three times daily for 3 days , by a r and omised cross-over study vs placebo in 12 mild to moderate essential hypertensive patients who had been treated for 1 month with amlodipine .  3 . Blood pressure , heart rate and vascular resistances in the upper limb ( Doppler ultrasound ) were measured . Plasma renin activity and urinary aldosterone , as well as indices of renal function , were evaluated . Urinary 2,3-dinor-6-keto-PGF1 alpha and 2,3-dinor-TXB2 , as well as 6-keto-PGF1 alpha and TXB2 , were measured as indices of systemic and renal PGI2 and TXA2 synthesis . 4 . Amlodipine normalised blood pressure and reduced upper limb vascular resistances ; it did not affect urinary prostanoid excretion . Short-term combined administration of ibuprofen result ed in , by comparison with placebo , inhibition of systemic PGI2 ( -80.5 ng 24 h-1 , 95 % CI -99.2 , -61.4 ; P < 0.001 ) and TXA2 ( -216.1 ng 24 h-1 , 95 % CI -276.5 , -155.8 ; P < 0.001 ) , together with an increase in systolic ( + 7.8 mm Hg , 95 % CI + 3.1 , + 12.3 ; P < 0.01 ) and diastolic ( + 3.9 mm Hg , 95 % CI + 1.2 , + 6.6 ; P < 0.01 ) blood pressure ; it had no significant effect on regional vascular resistances ( + 4.7 mm Hg ml-1 s , 95 % CI -5.6 , + 15.0 ) . Effects of ibuprofen on renal prostanoid synthesis were less marked , and there was no change in indices of renal function or hydro-electrolytic balance . ( ABSTRACT TRUNCATED AT 250 WORDS
Acetylsalicylic acid ( ASA ) did not reduce stroke or ' all cardiovascular events ' compared to placebo in primary prevention patients with elevated blood pressure and no prior cardiovascular disease .
Antiplatelet therapy with ASA for primary prevention in patients with elevated blood pressure provides a benefit , reduction in myocardial infa rct ion , which is negated by a harm of similar magnitude , increase in major haemorrhage .
The benefit of antiplatelet therapy for secondary prevention in patients with elevated blood pressure is many times greater than the harm .
Benefit has not been demonstrated for warfarin therapy alone or in combination with aspirin in patients with elevated blood pressure .
BACKGROUND Elevated systemic blood pressure results in high intravascular pressure but the main complications , coronary heart disease ( CHD ) , ischaemic strokes and peripheral vascular disease ( PVD ) , are related to thrombosis rather than haemorrhage .
Some complications related to elevated blood pressure , heart failure or atrial fibrillation , are themselves associated with stroke and thromboembolism .
Therefore it is important to investigate if antithrombotic therapy may be useful in preventing thrombosis-related complications in patients with elevated blood pressure .
OBJECTIVES To conduct a systematic review of the role of antiplatelet therapy and anticoagulation in patients with high blood pressure , including those with elevations in both systolic and diastolic blood pressure , isolated elevations of either systolic or diastolic blood pressure , 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 .
Ticlopidine , clopidogrel and newer antiplatelet agents such as prasugrel and ticagrelor have not been sufficiently evaluated in patients with high blood pressure .