Aspirin and hypertension

HICHAM_T2 · Nov 10, 2018

Hi
When I went to buy Aspirin for my wife's motherThe pharmacist told me it was not good for people with high blood pressure. Because this type of medication contains salt. Does salt really interfere with the pharmaceutical industry?

SimonCrox · Nov 10, 2018

There is an element of truth in this, but it is muddled.

ASPIRIN AND BP
One gives aspirin to prevent heart attacks and strokes, the pair of which are lumped under the title MACE - Major Adverse Cardiovascular Event. One can give the aspirin or whatever to prevent MACE in someone who has not had an event before - Primary Prevention; or one can give it after someone has had an event.
Aspirin increases adverse events to benefit ratio if blood pressure over 150 systolic (TW Meade, BMJ 2000) in people who had not yet had heart attack or stroke, primary prevention. In the past aspirin was given to hypertensive people as primary prevention because of a 6% reduction in MACE in the HOT trial, but now it is thought that risks outweigh benefits (bleeding) so aspirin is not now given in primary prevention.
So on modern guidance, your mother in law has had a stroke or heart attack or some other reason to push folk to prescribe aspirin, ie it is for secondary prevention. It is thought to be more beneficial than harmful in secondary prevention, and if her blood pressure is high, folk are under great pressure to drive it down to target.
So, your mother in law's BP is important to be addressed, but should not be a barrier to use of aspirin.
SALT AND ASPIRIN
All fizzy dispersible tablets are made this way by some chemical reaction that I forget, but contain a fair amount of sodium per dispersible tablet. So, one or two dispersible tablets make little difference, but say 8 dispersible co-codamols would.
Sorry - I can take a simple topic and make it complex
Best wishes

HICHAM_T2 · Nov 10, 2018

SimonCrox said:
There is an element of truth in this, but it is muddled.

ASPIRIN AND BP
One gives aspirin to prevent heart attacks and strokes, the pair of which are lumped under the title MACE - Major Adverse Cardiovascular Event. One can give the aspirin or whatever to prevent MACE in someone who has not had an event before - Primary Prevention; or one can give it after someone has had an event.
Aspirin increases adverse events to benefit ratio if blood pressure over 150 systolic (TW Meade, BMJ 2000) in people who had not yet had heart attack or stroke, primary prevention. In the past aspirin was given to hypertensive people as primary prevention because of a 6% reduction in MACE in the HOT trial, but now it is thought that risks outweigh benefits (bleeding) so aspirin is not now given in primary prevention.
So on modern guidance, your mother in law has had a stroke or heart attack or some other reason to push folk to prescribe aspirin, ie it is for secondary prevention. It is thought to be more beneficial than harmful in secondary prevention, and if her blood pressure is high, folk are under great pressure to drive it down to target.
So, your mother in law's BP is important to be addressed, but should not be a barrier to use of aspirin.
SALT AND ASPIRIN
All fizzy dispersible tablets are made this way by some chemical reaction that I forget, but contain a fair amount of sodium per dispersible tablet. So, one or two dispersible tablets make little difference, but say 8 dispersible co-codamols would.
Sorry - I can take a simple topic and make it complex
Best wishes

Thank you for all this informations her blood processer sometimes up to 220

donnellysdogs · Nov 10, 2018

SimonCrox said:
There is an element of truth in this, but it is muddled.

ASPIRIN AND BP
One gives aspirin to prevent heart attacks and strokes, the pair of which are lumped under the title MACE - Major Adverse Cardiovascular Event. One can give the aspirin or whatever to prevent MACE in someone who has not had an event before - Primary Prevention; or one can give it after someone has had an event.
Aspirin increases adverse events to benefit ratio if blood pressure over 150 systolic (TW Meade, BMJ 2000) in people who had not yet had heart attack or stroke, primary prevention. In the past aspirin was given to hypertensive people as primary prevention because of a 6% reduction in MACE in the HOT trial, but now it is thought that risks outweigh benefits (bleeding) so aspirin is not now given in primary prevention.
So on modern guidance, your mother in law has had a stroke or heart attack or some other reason to push folk to prescribe aspirin, ie it is for secondary prevention. It is thought to be more beneficial than harmful in secondary prevention, and if her blood pressure is high, folk are under great pressure to drive it down to target.
So, your mother in law's BP is important to be addressed, but should not be a barrier to use of aspirin.
SALT AND ASPIRIN
All fizzy dispersible tablets are made this way by some chemical reaction that I forget, but contain a fair amount of sodium per dispersible tablet. So, one or two dispersible tablets make little difference, but say 8 dispersible co-codamols would.
Sorry - I can take a simple topic and make it complex
Best wishes

I read aspirin details as important, as aspirin is also a trial treatment for post breast cancer.... thank you for your information....

SimonCrox · Nov 11, 2018

donnellysdogs said:
I read aspirin details as important, as aspirin is also a trial treatment for post breast cancer.... thank you for your information....

I didn't know that - thanks for info. A Lancet paper showed that a 5 year course of aspirin was also protective against future bowel cancer.
best wishes

SimonCrox · Nov 11, 2018

HICHAM_T2 said:
Thank you for all this informations her blood processer sometimes up to 220

Blood pressure of 220 systolic (top figure) is very high. What is it generally?

Over the age of 55, one only really needs to look at the systolic figure, as you have done.

Target BP would depend on whether under or over 80 years old, but whatever, 220 is too high.

I presume that she is on treatment for her BP that she takes.

Does she see her GP or a specialist for her BP?
Best wishes

lindisfel · Nov 11, 2018

Taking drugs as always is mixed, aspirin is not without its problems. Re: it is not as protective from stroke as the other Novel like Dabigatran and non Novel anticoagulants like Warfarin.

I remember my health care assistant telling me her grandma who was on aspirin died of a stroke and like me, who she was testing, should have been on Warfarin.
But Warfarin wouldn't work for me.

If one has kidney issues NSaids like aspirin and Ibrufen are not recommended.

Therapeutic aspirin should not be a problem with sodium, it is in 75mgs tablets a quarter of a normal tablet.

At 220 systolic at whatever age it is far too high and needs medication and diet changes, it should be under 140/80. Mine is controlled at c.120/70 atm and I have had htn thirty years and am 80 next birthday.
regards
Derek

HICHAM_T2 · Nov 11, 2018

SimonCrox said:
Blood pressure of 220 systolic (top figure) is very high. What is it generally?

Over the age of 55, one only really needs to look at the systolic figure, as you have done.

Target BP would depend on whether under or over 80 years old, but whatever, 220 is too high.

I presume that she is on treatment for her BP that she takes.

Does she see her GP or a specialist for her BP?
Best wishes

Hi and thank you for advice
She has 62 years old i'm not sure exactly not always he see her GP

Dark Horse · Nov 11, 2018

This is what Blood Pressure UK say:-

Should I be taking aspirin as well?
If you have high blood pressure you should only take aspirin if you have an increased risk of a heart attack or stroke and only when your blood pressure is well controlled. You should talk to your doctor before starting aspirin.

The reason for this is that aspirin affects the way your blood clots and is therefore more likely to cause bleeding from the stomach and intestines. Aspirin may also be linked to an increased risk of strokes from bleeding directly into the brain.

You should not take aspirin yourself regularly unless your doctor has said that it is right for you to take it.
http://www.bloodpressureuk.org/BloodPressureandyou/FAQs/Medicinesforhighbloodpressure

SimonCrox · Nov 11, 2018

lindisfel said:
Taking drugs as always is mixed, aspirin is not without its problems. Re: it is not as protective from stroke as the other Novel like Dabigatran and non Novel anticoagulants like Warfarin.

I remember my health care assistant telling me her grandma who was on aspirin died of a stroke and like me, who she was testing, should have been on Warfarin.
But Warfarin wouldn't work for me.

If one has kidney issues NSaids like aspirin and Ibrufen are not recommended.

Therapeutic aspirin should not be a problem with sodium, it is in 75mgs tablets a quarter of a normal tablet.

At 220 systolic at whatever age it is far too high and needs medication and diet changes, it should be under 140/80. Mine is controlled at c.120/70 atm and I have had htn thirty years and am 80 next birthday.
regards
Derek

Great news about your blood pressure.

Aspirin and other antiplatelet agents such as clopidogrel are used to stop blood vessels clotting up on areas of hardening of arteries.
Warfarin and the New Oral Anti Coagulants are used to stop clots forming in the heart if it is beating irregularly (atrial fibrillation) with the risk of throwing off clot to cause a stroke.
So, one uses whatever is appropriate for the condition. In atrial fibrillation, aspirin does not stop strokes. If normal heart beat with hardening of arteries in neck, warfarin does not protect from strokes.
I was sorry to hear of the grandma having a stroke despite aspirin. Basically, in hardening of the arteries, aspirin drops the risk of stroke by about one third. So, if we had a group of 30 people that we knew would have this kind of stroke over next year, aspirin would stop 10 people from having a stroke, but 20 people would still have a stroke. So, this is a good risk reduction, but not so good for the 20 that still have a stroke. This is why one also targets blood pressure and cholesterol..

Totally agree about the comment about NSAIDS / anti-inflammatories; I cannot understand why one can buy them over the counter with the risk of peptic ulcers, renal impairment, heart attack, stroke, hypertension, worse heart failure etc.

best wishes

SimonCrox · Nov 12, 2018

HICHAM_T2 said:
Hi and thank you for advice
She has 62 years old i'm not sure exactly not always he see her GP

62 is quite young medically, but one cannot make many comments on the information that we have.

But at 62, has she had a heart attack, angina, mini stroke or stroke which would suggest aspirin is useful? Might be useful in hardening of arteries elsewhere eg legs. If not, she should question her GP about the aspirin.

Not sure of what her BP levels are, so difficult to make suggestions about further help.
Genaral advice for BP control is:-
1: Avoid salt
2: Keep alcohol intake down eg 3 units (30 gm) per day max in a female
3: Keep weight (Body Mass Index (BMI) down to healthy level (20-25 for european)

It is really valuable to have several measurements of BP to get an idea of what is going on.

"She has 62 years old" - ca veut dire que vous etes francophone? Sans aucune doute, votre anglais serait meilleur que mon francais.

Best wishes

HICHAM_T2 · Nov 12, 2018

SimonCrox said:
62 is quite young medically, but one cannot make many comments on the information that we have.

But at 62, has she had a heart attack, angina, mini stroke or stroke which would suggest aspirin is useful? Might be useful in hardening of arteries elsewhere eg legs. If not, she should question her GP about the aspirin.

Not sure of what her BP levels are, so difficult to make suggestions about further help.
Genaral advice for BP control is:-
1: Avoid salt
2: Keep alcohol intake down eg 3 units (30 gm) per day max in a female
3: Keep weight (Body Mass Index (BMI) down to healthy level (20-25 for european)

It is really valuable to have several measurements of BP to get an idea of what is going on.

"She has 62 years old" - ca veut dire que vous etes francophone? Sans aucune doute, votre anglais serait meilleur que mon francais.

Best wishes

Hi
Thanks for your advice
In fact, she is overweight and has heart problems.
My English language was bad sometimes forced to translate

SimonCrox · Nov 12, 2018

HICHAM_T2 said:
Hi
Thanks for your advice
In fact, she is overweight and has heart problems.
My English language was bad sometimes forced to translate

I guess the heart problems are why she is on the aspirin, and that the heart problems are coronoary heart disease / angina / heart attack (maladie coronarienne/ angine / infarctus) and not atrial fibrillation (fibrilation auriculaire).

Since BP control might be difficult, it is important to tackle ofther risk factors; does she take a statin?

Your English is fine - pas de soucis.

Vous n'avez pas dit si vous êtes francophone?

"Un homme qui parle trois langues est trilingue. Un homme qui parle deux langues est bilingue. Un homme qui ne parle qu'une langue est anglais.”

Best wishes

HICHAM_T2 · Nov 12, 2018

Hi again Yes, she is taking medication for cholesterol

It's funny that the French I have is worse than English but don't worry I can speak English a little
I'm from Morocco Arabic it's default language

Aspirin and hypertension

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