Cardioprotective value of aspirin in primary prevention is greater the lower the blood pressure

In primary prevention, middle aged men at increased risk of coronary heart disease seem to benefit more from aspirin when systolic blood pressure is lower. The use of aspirin, often self prescribed, in those who have so far not experienced heart attacks requires careful consideration as only a few episodes will be prevented and even low doses of aspirin may carry an appreciable risk of potentially serious bleeding. The US physicians trial suggested that older men and those with low cholesterol concentrations would benefit most, but the UK thrombosis prevention trial (p 13) does not confirm these suggestions. The UK trial in 5499 men treated over nearly seven years showed that the risk of heart attacks was reduced by about half in those with lower blood pressures whereas there was little if any effect in those with higher pressures. These findings need to be confirmed or refuted, however, before they are taken as firm evidence in clinical practice.

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