Treatment of patient with high-risk hypertension: do we need antiplatelet therapy?

This review summarizes the main problems of acetylsalicylic acid (ASA) use in clinical practice. The prescription of antiplatelet therapy for primary cardiovascular prevention is the most controversial. The available clinical guidelines are contradictory. Antiplatelet drugs are the most commonly prescribed medication in routine practice, and the rates are growing. The article reviews the data of clinical trials and basic meta-analysis on the effectiveness and safety of ASA in patients with hypertension (HTN), diabetes mellitus (DM), renal dysfunction, as well as age- and gender-associated differences. Additional criteria are considered in high-risk patients. A special attention is paid to the main clinical recommendations regarding the use of ASA in patients with HTN and DM. Common use of ASA increases the risk of complications and requires the search for possible preventive approaches. Thus, the main risk groups for gastrointestinal bleeding are listed. Moreover, the main preventive approaches regarding the various forms of ASA, the use of adjunctive therapy by secretion blockers and eradication therapy are discussed.