Aspirin and blood pressure: Effects when used alone or in combination with antihypertensive drugs

Abstract

Arterial hypertension is a major risk factor for cardiovascular and renal events. Lowering blood pressure is thus an important strategy for reducing morbidity and mortality. Since low-dose aspirin is a cornerstone in the prevention of adverse cardiovascular outcomes, combined treatment with aspirin and antihypertensive drugs is very common. However, the impact of aspirin therapy on blood pressure control remains a subject of intense debate. Recent data suggest that the cardioprotective action of aspirin extends beyond its well-known antithrombotic effect. Aspirin has been shown to trigger the synthesis of specialized pro-resolving lipid mediators from arachidonic acid and omega-3 fatty acids. These novel anti-inflammatory and pro-resolving mediators actively stimulate the resolution of inflammation and tissue regeneration. Additionally, they may contribute to other protective effects on redox status and vascular reactivity that have also been attributed to aspirin. Of note, aspirin has been shown to improve vasodilation through cyclooxygenase-independent mechanisms. On the other hand, higher aspirin doses have been reported to exert a negative impact on blood pressure due to inhibition of cyclooxygenase-2 activity, which reduces renal blood flow, glomerular filtration rate and sodium and water excretion. This review aims to provide an overview of the effects of aspirin on blood pressure and the underlying mechanisms, focusing on the interaction between aspirin and antihypertensive drugs. Studies in both experimental and human hypertension are presented.

Favourable hypotensive effect after standardised tomato extract treatment in hypertensive subjects at high cardiovascular risk: a randomised controlled trial

“…During the study, it was observed that both ASA and STE added to standard therapy affect BP as well as antiplatelet action. Despite the widespread use of ASA, in the literature there are few reports of ASA hypotensive effects [14]. Therefore, it was decided to publish data on the effect of the two agents ,i.e.…”

The influence of adding tomato extract and acetylsalicylic acid to hypotensive therapy on the daily blood pressure profiles of patients with arterial hypertension and high cardiovascular risk

“…Similar results were published by Avanzini et al ; after administering small doses of ASA, the researchers noted no reductions in SBP or DBP in patients treated for arterial hypertension [ 18 ]. Acetylsalicylic acid in small doses does not influence blood pressure values, nor does it reduce the efficacy of hypotensive medication [ 19 ]. This may suggest that the influence of ASA on blood pressure depends on the dosage, which, considering the dose of 75 mg used in our study, might explain the lack of the agent’s influence on arterial blood pressure.…”

Pleiotropic Effects of Acetylsalicylic Acid after Coronary Artery Bypass Grafting—Beyond Platelet Inhibition

“…First, low-dose ASA treatment is associated with stronger decrease in blood pressure, in comparison to high-dose [ 53 ]. The underlying mechanism is based on the inhibition of COX-2 by high-dose ASA, but not by low-dose ASA.…”

“…The underlying mechanism is based on the inhibition of COX-2 by high-dose ASA, but not by low-dose ASA. High-dose ASA leads to reduction of renal blood flow, glomerular filtration rate, sodium, and water excretion [ 53 ], which are the reasons for against using high doses of ASA in clinical practice. Another mechanism which seems to play a role in ASA hypotensive effect is a COX-independent pathway which revolves around proline-rich tyrosine kinase 2 (Pyk2).…”

“…Through the inhibition of the Pyk2-associated pathway in vascular smooth muscle cells, ASA and other salicylates may lower the blood pressure. This phenomenon is unique for ASA doses of higher concentrations than those required to inhibit COX [ 53 ].…”