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Am Fam Physician. 2023;108(4):349-350

This clinical content conforms to AAFP criteria for CME.

Author disclosure: No relevant financial relationships.

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).

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These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, assistant medical editor.

A collection of Cochrane for Clinicians published in AFP is available at

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