Aspirin therapy in hypertensive patients with eGFR < 45 ml/min/1.73 m2 reduced major cardiovascular events by 66% (95% CI: 33% to 83%; p trend=0.03) compared to placebo.
RCT (n=18,597)
Does aspirin 75 mg reduce major cardiovascular events and mortality in patients with diastolic hypertension and chronic kidney disease?
Aspirin 75 mg provides substantial absolute reductions in major cardiovascular events and mortality in hypertensive patients with advanced CKD, which appears to outweigh the increased risk of major bleeding.
Effect estimate: 66% reduction (for eGFR < 45 ml/min/1.73 m2) (95% CI 33% to 83%)
p-value: p=0.03 (p trend)
OBJECTIVES: The purpose of this study was to determine the benefit and risk associated with antiplatelet therapy in the chronic kidney disease (CKD) population. BACKGROUND: Cardiovascular and possibly bleeding risks are elevated in patients with CKD. The balance of benefit and harm associated with antiplatelet therapy remains uncertain. METHODS: The HOT (Hypertension Optimal Treatment) study randomly assigned participants with diastolic hypertension to aspirin (75 mg) or placebo. Study treatment effects were calculated using univariate proportional hazards regression models stratified by baseline estimated glomerular filtration rate (eGFR) with trends tested by adding interaction terms. End points included major cardiovascular events, total mortality, and major bleeding. RESULTS: The study included 18,597 participants treated for 3.8 years. Baseline eGFR was < 60 ml/min/1.73 m(2) in 3,619 participants. Major cardiovascular events were reduced by 9% (95% confidence interval CI: -9% to 24%), 15% (95% CI: -17% to 39%), and 66% (95% CI: 33% to 83%) for patients with baseline eGFR of ≥ 60, 45 to 59, and < 45 ml/min/1.73 m(2), respectively (p trend = 0.03). Total mortality was reduced by 0% (95% CI: -20% to 17%), 11% (95% CI: -31% to 40%), and 49% (95% CI: 6% to 73%), respectively (p trend = 0.04). Major bleeding events were nonsignificantly greater with lower eGFR (hazard ratio HR: 1.52 95% CI: 1.11 to 2.08, HR: 1.70 95% CI: 0.74 to 3.88, and HR: 2.81 95% CI: 0.92 to 8.84, respectively; p trend = 0.30). Among every 1,000 persons with eGFR < 45 ml/min/1.73 m(2) treated for 3.8 years, 76 major cardiovascular events and 54 all-cause deaths will be prevented while 27 excess major bleeds will occur. CONCLUSIONS: Aspirin therapy produces greater absolute reduction in major cardiovascular events and mortality in hypertensive patients with CKD than with normal kidney function. An increased risk of major bleeding appears to be outweighed by the substantial benefits.
Jardine et al. (Wed,) conducted a rct in Hypertension with chronic kidney disease (n=18,597). Aspirin vs. Placebo was evaluated on Major cardiovascular events (66% reduction (for eGFR < 45 ml/min/1.73 m2), 95% CI 33% to 83%, p=0.03 (p trend)). Aspirin therapy in hypertensive patients with eGFR < 45 ml/min/1.73 m2 reduced major cardiovascular events by 66% (95% CI: 33% to 83%; p trend=0.03) compared to placebo.