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Vol. 36. Issue 7 - 8.
Pages 551-567 (July - August 2017)
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Vol. 36. Issue 7 - 8.
Pages 551-567 (July - August 2017)
Review Article
DOI: 10.1016/j.repce.2017.05.008
Open Access
Aspirin and blood pressure: Effects when used alone or in combination with antihypertensive drugs
Aspirina e pressão arterial: efeitos do uso isolado ou em associação com fármacos anti-hipertensores
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Ana Catarina Costaa, Marta Reina-Coutoa,b,c, António Albino-Teixeiraa,b,
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albinote@med.up.pt

Corresponding author.
, Teresa Sousaa,b,
Corresponding author
tsousa@med.up.pt

Corresponding author.
a Departamento de Biomedicina – Unidade de Farmacologia e Terapêutica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
b MedInUP – Centro de Investigação Farmacológica e Inovação Medicamentosa, Universidade do Porto, Porto, Portugal
c Departamento de Medicina Intensiva, Centro Hospitalar São João, Porto, Portugal
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Tables (2)
Table 1. Interaction of aspirin with antihypertensive drugs in experimental models of hypertension.
Table 2. Interaction of aspirin with antihypertensive drugs in hypertensive patients.
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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.

Keywords:
Aspirin
Pharmacologic actions
Blood pressure
Hypertension
Antihypertensive agents
Resumo

A hipertensão arterial representa um fator de risco major para eventos cardiovasculares e renais. Por esse motivo, a redução da pressão arterial é uma estratégia importante para a diminuição da morbilidade e mortalidade. Como a aspirina em dose baixa constitui a terapêutica base na prevenção de eventos cardiovasculares, a sua associação com fármacos anti-hipertensores é muito comum. No entanto, o impacto da aspirina no controlo da pressão arterial permanece um tema de intensa discussão.

Estudos recentes sugerem que a ação cardioprotetora da aspirina não está limitada ao seu conhecido efeito antitrombótico. A aspirina ativa a síntese de mediadores pró-resolutivos especializados a partir do ácido araquidónico e de ácidos gordos ómega-3. Estes novos mediadores anti-inflamatórios e pró-resolutivos estimulam ativamente a resolução da inflamação e a regeneração tecidual. Adicionalmente, poderão contribuir para os efeitos protetores no estado redox e na reatividade vascular que têm sido atribuídos à aspirina. É de sublinhar que a aspirina parece também melhorar a vasodilatação por mecanismos independentes da inibição da cicloxigenase. Por outro lado, o uso de aspirina em doses altas parece exercer um efeito negativo na pressão arterial devido à inibição da atividade da cicloxigenase-2 e consequente redução do fluxo sanguíneo renal, da taxa de filtração glomerular e da excreção de sódio e água.

Este artigo pretende rever os efeitos da aspirina na pressão arterial e mecanismos subjacentes, com enfoque na interação entre a aspirina e os fármacos anti-hipertensores. São apresentados estudos na hipertensão experimental e humana.

Palavras-chave:
Aspirina
Ações farmacológicas
Pressão arterial
Hipertensão
Fármacos anti-hipertensores
List of abbreviations
15-epi-LXA4

15R-epimeric lipoxin A4

15-epi-LXB4

15R-epimeric lipoxin B4

15-epi-LXs

15-epi-lipoxins

15R-HETE

15(R)-hydroxyeicosatetraenoic acid

17R-HDHA

17R-hydroxydocosahexaenoic acid

18R-HETE

18R-hydroxyeicosapentaenoic acid

5-LOX

5-lipoxygenase

AA

arachidonic acid

ABPM

ambulatory blood pressure measurement

ACEI

angiotensin-converting enzyme inhibitors

Ang II

angiotensin II

ARB

angiotensin receptor blockers

AT-PD

aspirin triggered protectin

AT-RvD1

aspirin triggered resolvin D1

AT-RvD2

aspirin triggered resolvin D2

AT-RvD3

aspirin triggered resolvin D3

AT-RvD4

aspirin triggered resolvin D4

ATL

aspirin-triggered lipoxins

BB

beta-blockers

BP

blood pressure

cGMP

cyclic guanosine monophosphate

COX-1

cyclooxygenase-1

COX-2

cyclooxygenase-2

DBP

diastolic blood pressure

DHA

docosahexaenoic acid

eNOS

endothelial nitric oxide synthase

EPA

eicosapentaenoic acid

HDR

hygienic-dietary recommendations

HOT

Hypertension Optimal Treatment

LIFE

Losartan Intervention For Endpoint reduction in hypertension

LOX

lipoxygenase

LXs

lipoxins

NADPH oxidase

nicotinamide adenine dinucleotide phosphate oxidase

NFκB

nuclear factor kappa B

NO

nitric oxide

NSAIDs

nonsteroidal anti-inflammatory drugs

O2

superoxide

PDs

protectins

PGE2

prostaglandin E2

PGI2

prostacyclin

PGs

prostaglandins

PRA

plasma renin activity

PYK2

proline-rich tyrosine kinase 2

ROS

reactive oxygen species

RvE1

resolvin E1

RvE2

resolvin E2

Rvs

resolvins

SBP

systolic blood pressure

SHR

spontaneously hypertensive rats

SD

Sprague Dawley

SMC

smooth muscle cells

SPMs

specialized pro-resolving lipid mediators

TXA2

thromboxane A2

TXB2

thromboxane B2

WKY

Wistar-Kyoto rats

Full Text
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By checking that you are a health professional, you are stating that you are aware and accept that the Portuguese Journal of Cardiology (RPC) is the Data Controller that processes the personal information of users of its website, with its registered office at Campo Grande, n.º 28, 13.º, 1700-093 Lisbon, telephone 217 970 685 and 217 817 630, fax 217 931 095, and email revista@spc.pt. I declare for all purposes that the information provided herein is accurate and correct.