Clinical Question

Does the use of aspirin decrease the risk of all-cause or cardiovascular mortality in patients with hypertension?

Evidence-Based Answer

The use of aspirin for primary prevention likely decreases the risk of all cardiovascular events (number needed to treat [NNT] = 175) but does not modify all-cause or cardiovascular mortality and increases the risk of major bleeding (number needed to harm [NNH] = 175) in patients with hypertension.¹

Practice Pointers

Cardiovascular disease (CVD) is the leading cause of mortality worldwide, causing 17.9 million deaths (32% of the total) in 2019.² Hypertension is a significant risk factor in the progression of morbidity and increases all-cause mortality.³ The authors of this review sought to determine the value of taking aspirin as the primary prevention of all-cause and cardiovascular mortality in patients with hypertension.

This Cochrane review included six single- or double-blinded randomized controlled trials (published between 1996 and 2019) involving 61,015 participants who were 30 to 85 years of age.¹ Inclusion criteria were a systolic blood pressure of 140 mm Hg or greater or a diastolic blood pressure of 90 mm Hg or greater. The treatment durations were between three months and five years. Primary outcomes were all-cause and cardiovascular mortality. Secondary outcomes were nonfatal cardiovascular events and major bleeding events. Major bleeding was defined as hemorrhagic stroke or blood loss involving a decrease in hemoglobin greater than 2 g per dL (20 g per L).