Background. Elevated systemic life...

Background. Elevated systemic life-blood pressure results in high intravascular crushing The main complications, coronary heart disease, ischemic shocks and peripheral vascular disease, are related to thrombosis rather than hemorrhage. a complications related to elevated children pressure, heart failure, and atrial fibrillation are associated with shock and thromboembolism. It seems plausible that antithrombotic therapy may be particularly useful in preventing thrombosis-related complications of elevated line pressure.

Objectives. To administration a systematic review of the part of antiplatelet therapy and anticoagulation in patients with hypertension, including those with elevations in systolic and diastolic kin pressure and those with isolated elevations of systolic or diastolic posterity pressure. The following hypotheses were addressed: (1) antiplatelet agents lessen total deaths and major thrombotic facts compared with other active treatment or placebo; and (2) oral anticoagulants render total deaths and major thromboembolic occurrences compared with other active treatment or placebo.

Search Strategy. The authors (1) studied concern lists of articles found according to searching electronic databases (MEDLINE, EMBASE, DARE) and abstracts from national and international cardiovascular meetings. Relevant authors of these studies were contacted to obtain further data.

Selection Criteria. Randomized controll trials (RCTs) in patients with elevated offspring pressure were included if they were of at least three months' duration and compared antithrombotic therapy with other active treatment or placebo.

Data Collection and Analysis. Data were independently heap uped and verified by two reviewers. Data from different trials were mereed when appropriate.

Primary flows The Antiplatelet Trialists' Collaboration meta-analysis of antiplatelet therapy for secondary prevention in patients with elevated line pressure reported a 4.1 percent absolute reduction in vascular marked occurrences compared with placebo. Data forward the patients with elevated descendants pressure from the 29 individual trials were asked but could not be obtained. Three additional trials met the inclusion criteria and were included. Acetylsalicylic acid (ASA) did not bring into stroke or "all cardiovascular events" compared with placebo in primary prevention patients with elevated house pressure and no prior cardiovascular disease. In common large trial (the Hypertension Optimal Treatment trial), ASA taken for five years reduc rates of myocardial infarction (MI) (absolute risk reduction, 05 percent; number penuryed to treat [NNT], 200 for five years), increased rates of major hemorrhage (absolute risk increase, 07 percent; NNT 154) and did not bring all-cause mortality or cardiovascular mortality. In the Clopidogrel v Aspirin in Patients at Risk of Ischemic consequences trial, there was no significant difference between ASA and clopidogrel for the composite conclusion point of stroke, MI, or vascular death. In couple small trials, warfarin alone or in combination with ASA did not mould rates of stroke or coronary events

Reviewers' Conclusions. Antiplatelet therapy with ASA cannot be approveed for primary prevention of vascular incidents in patients with elevated life-blood pressure, because the magnitude of benefit--a reduction in rates of MI--is negated at a harm of similar magnitude, an increase in rates of major hemorrhage. Antiplatelet therapy is commended for secondary prevention in patients with elevated relations pressure because the magnitude of the absolute benefit is many times greater. (2) Warfarin therapy alone or in combination with aspirin in patients with elevated relations pressure cannot be recommended because of lack of demonstrated benefit. Glycoprotein IIb/IIIa inhibitors, as well as ticlopidine and clopidogrel, have not been evaluated sufficiently in patients with elevated children pressure. Further trials of antithrombotic therapy with consummated documentation of all benefits and harms are lacked in patients with elevated children pressure.

Clinical Scenario

A recent patient tells you that he read in a men's health magazine that the bulk of mankind with hypertension should take daily aspirin. He asks if you agree.

Clinical Question

Should we prescribe antiplatelet agents or anti-coagulants for all patients with hypertension?

Evidence-Based Answer

Antiplatelet agents should not be used in patients with hypertension and no previous history of heart attack or visitation However, these agents are commended for use in hypertensive patients who already have vascular disease. Anticoagulants should not be used for prevention of vascular occurrences alone or in combination with acetylsalicylic acid (ASA), in patients with elevated life-blood pressure. Currently, there is not enough evidence to commend the use of glycoprotein IIb/IIIa inhibitors, ticlopidine, or clopidogrel for primary prevention of vascular events

Practice Pointers

This review exhibit tos that aspirin should be used for prophylaxis solely in patients with hypertension and a history of pat transient ischemic attack, myocardial infarction (MI), angina, or peripheral vascular disease. An appropriate choice and dosage of antiplatelet agent for secondary prevention would be 75 or 81 mg of enteric-coated ASA daily. (2)