Aspirin appears beneficial in hypertensive patients with chronic kidney disease

January 01, 0001

Aspirin appears beneficial in hypertensive patients with chronic kidney disease

Cardiovascular and possibly bleeding risks are elevated in patients with CKD. The balance of benefit and harm associated with antiplatelet therapy remains uncertain. The purpose of this study by researchers from Australia and Italy was to determine the benefit and risk associated with antiplatelet therapy in the chronic kidney disease (CKD) population. The HOT (Hypertension Optimal Treatment) study randomly assigned participants with diastolic hypertension to aspirin (75 mg) or placebo. The study included 18,597 participants treated for 3.8 years. Baseline eGFR was less than 60 ml/min/1.73 m2 in 3,619 participants.

Major cardiovascular events were reduced by 9%, 15% and 66% for patients with baseline eGFR of 60, 45 to 59, and less than 45 ml/min/1.73 m2, respectively (significant). Total mortality was reduced by 0%, 11% and 49% respectively (significant). Major bleeding events were nonsignificantly greater with lower eGFR (hazard ratio, HR: 1.52, 1.70 and HR: 2.81 respectively). Among every 1,000 persons with eGFR less than 45 ml/min/1.73 m2 treated for 3.8 years, 76 major cardiovascular events and 54 all-cause deaths will be prevented while 27 excess major bleeds will occur.

The researchers concluded: "Aspirin therapy produces greater absolute reduction in major cardiovascular events and mortality in hypertensive patients with CKD than with normal kidney function. An increased risk of major bleeding appears to be outweighed by the substantial benefits."

This is a select group and not reason for open slather with aspirin generally. Far more information is required.

For the full abstract, click here.

J Am Coll Cardiol 56(12):956-965, 14 September 2010
© 2010 by the American College of Cardiology Foundation
Aspirin Is Beneficial in Hypertensive Patients With Chronic Kidney Disease: A Post-Hoc Subgroup Analysis of a Randomized Controlled Trial. Meg J. Jardine, Toshiharu Ninomiya, Vlado Perkovic et al. Correspondence to Vlado Perkovic: [email protected]

Category: K. Circulatory, U. Urinary System. Keywords: aspirin, bleeding, cardiovascular risk, chronic kidney disease, mortality, primary prevention, risk-benefit analysis, post-hoc subgroup analysis of a randomized controlled trial, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 24 September 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.