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Low-dose aspirin plays an essential role in the prevention of adverse cardiovascular outcomes&#44; especially in patients with previous cardiovascular events&#46;<a class="elsevierStyleCrossRefs" href="#bib0440"><span class="elsevierStyleSup">1&#44;5&#8211;7</span></a> Although it is commonly combined with antihypertensive medication&#44; aspirin therapy is controversial in individuals without a history of cardiovascular disease&#46; According to the 2013 European guidelines for the management of hypertension&#44; low-dose aspirin should be prescribed for controlled hypertensive patients with previous cardiovascular events and considered for hypertensive patients with renal dysfunction or high cardiovascular risk&#44; but is not recommended for low-to-moderate risk hypertensive patients in whom absolute benefit and harm are equivalent&#46;<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">1</span></a> Similar recommendations on aspirin use have been reported in the recent European guidelines for cardiovascular disease prevention&#46;<a class="elsevierStyleCrossRef" href="#bib0475"><span class="elsevierStyleSup">8</span></a></p><p id="par0245" class="elsevierStylePara elsevierViewall">The impact on BP of the combination of aspirin with first-line antihypertensive drugs&#44; such as beta-blockers &#40;BBs&#41;&#44; angiotensin converting enzyme inhibitors &#40;ACEIs&#41; and angiotensin receptor blockers &#40;ARBs&#41;&#44; has also been the subject of intense debate&#46; There are reports of negative interactions with BBs or ACEIs&#44;<a class="elsevierStyleCrossRefs" href="#bib0480"><span class="elsevierStyleSup">9&#8211;12</span></a> while other studies have shown no influence on the BP-lowering effect of ACEIs and ARBs&#46;<a class="elsevierStyleCrossRefs" href="#bib0500"><span class="elsevierStyleSup">13&#8211;15</span></a> Discussion of the benefits and harms of aspirin therapy in patients taking antihypertensive drugs extends to its effects on other cardiovascular parameters or endpoints&#46;<a class="elsevierStyleCrossRefs" href="#bib0510"><span class="elsevierStyleSup">15&#8211;17</span></a></p><p id="par0250" class="elsevierStylePara elsevierViewall">The present review aims to provide an overview of the effects of aspirin on blood pressure and the underlying mechanisms&#44; focusing on the interaction between aspirin and antihypertensive drugs&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Aspirin and inhibition of cyclooxygenase-1 and cyclooxygenase-2</span><p id="par0255" class="elsevierStylePara elsevierViewall">Aspirin&#39;s pharmacological effects have been attributed to the inhibition of cyclooxygenase &#40;COX&#41; enzymatic activity and further arachidonic acid &#40;AA&#41; metabolism&#46;<a class="elsevierStyleCrossRef" href="#bib0525"><span class="elsevierStyleSup">18</span></a> COX-1 is a constitutively expressed enzyme isoform responsible for the synthesis of prostanoids from AA&#46; These include thromboxane A<span class="elsevierStyleInf">2</span> &#40;TXA<span class="elsevierStyleInf">2</span>&#41; and prostaglandins &#40;PGs&#41;&#44; which mediate various homeostatic functions such as gastric protection&#44; renal blood flow regulation and platelet aggregation&#46; In contrast&#44; the COX-2 isoform is mostly expressed in response to inflammatory stimuli&#44; mitogens and growth factors&#44; and generates PGs involved in pain signaling&#44; fever and tissue repair&#44; although it is also constitutively expressed in the macula densa and renal medulla&#44; contributing to the regulation of kidney function&#46;<a class="elsevierStyleCrossRefs" href="#bib0525"><span class="elsevierStyleSup">18&#8211;21</span></a></p><p id="par0260" class="elsevierStylePara elsevierViewall">The irreversible acetylation of COX-1 by low-dose aspirin reduces TXA<span class="elsevierStyleInf">2</span> biosynthesis in platelets&#44; which inhibits platelet aggregation&#44; thus contributing to cardioprotection&#46;<a class="elsevierStyleCrossRefs" href="#bib0525"><span class="elsevierStyleSup">18&#44;22</span></a> In addition&#44; the decrease in TXA<span class="elsevierStyleInf">2</span> levels may also account for the attenuation of vasoconstriction&#46;<a class="elsevierStyleCrossRefs" href="#bib0525"><span class="elsevierStyleSup">18&#44;23</span></a> Higher aspirin doses are required to block COX-2 activity and achieve analgesic&#44; antipyretic and anti-inflammatory effects&#46; COX-2 blockade decreases the synthesis of prostacyclin &#40;PGI<span class="elsevierStyleInf">2</span>&#41;&#44; a potent vasodilator and inhibitor of platelet aggregation&#44; and of other PGs such as prostaglandin E<span class="elsevierStyleInf">2</span> &#40;PGE<span class="elsevierStyleInf">2</span>&#41; that are involved in the control of BP and renal function&#46;<a class="elsevierStyleCrossRefs" href="#bib0525"><span class="elsevierStyleSup">18&#44;21&#44;22&#44;24</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Aspirin and production of pro-resolving lipid mediators</span><p id="par0265" class="elsevierStylePara elsevierViewall">In recent years&#44; a new paradigm of the inflammatory process has emerged&#44; with the discovery of specialized pro-resolving lipid mediators &#40;SPMs&#41; such as lipoxins &#40;LXs&#41;&#44; resolvins &#40;Rvs&#41; and protectins &#40;PDs&#41;&#44; that actively stimulate the resolution of inflammation and tissue regeneration&#46;<a class="elsevierStyleCrossRef" href="#bib0560"><span class="elsevierStyleSup">25</span></a> SPMs are biosynthesized in transcellular processes involving AA or omega-3 fatty acids as precursors and the cooperation of several lipoxygenases &#40;LOXs&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0565"><span class="elsevierStyleSup">26</span></a></p><p id="par0270" class="elsevierStylePara elsevierViewall">Interestingly&#44; the acetylation of COX-2 by aspirin triggers the production of SPMs&#46; In contrast to what occurs with COX-1&#44; which becomes irreversibly inhibited&#44; COX-2 acetylation by aspirin only changes its activity profile&#44; yielding 15&#40;R&#41;-hydroxyeicosatetraenoic acid &#40;15R-HETE&#41; from AA&#44; instead of the PG precursor PGH<span class="elsevierStyleInf">2</span>&#46; 15R-HETE is further metabolized into 15R-epimeric LXA<span class="elsevierStyleInf">4</span> &#40;15-epi-LXA<span class="elsevierStyleInf">4</span>&#41; or 15R-epimeric LXB<span class="elsevierStyleInf">4</span> &#40;15-epi-LXB<span class="elsevierStyleInf">4</span>&#41;&#44; which are also known as aspirin-triggered LXs &#40;ATL&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0565"><span class="elsevierStyleSup">26&#8211;28</span></a> Of note&#44; this effect appears to be aspirin-specific&#44; since it is not shared by other nonsteroidal anti-inflammatory drugs &#40;NSAIDs&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0570"><span class="elsevierStyleSup">27&#44;29</span></a> LXs and ATL exert several anti-inflammatory and pro-resolving effects&#44; including inhibition of neutrophil recruitment&#44; stimulation of neutrophil apoptosis and removal by macrophages&#44; inhibition of proinflammatory cytokine synthesis&#44; and stimulation of anti-inflammatory cytokine production&#46;<a class="elsevierStyleCrossRef" href="#bib0565"><span class="elsevierStyleSup">26</span></a> LXs and ATL also inhibit generation of reactive oxygen species &#40;ROS&#41;&#44; induce expression of antioxidant molecules and stimulate nitric oxide &#40;NO&#41; and PGI<span class="elsevierStyleInf">2</span> production and endothelium-dependent vasodilation&#46;<a class="elsevierStyleCrossRefs" href="#bib0565"><span class="elsevierStyleSup">26&#44;30</span></a> ATL biosynthesis has been demonstrated in healthy subjects treated with low-dose aspirin for eight weeks&#46; Since ATL was generated in sufficient levels to achieve anti-inflammatory and pro-resolving effects&#44; it is conceivable that it contributes to the cardiovascular benefits of aspirin&#46;<a class="elsevierStyleCrossRef" href="#bib0580"><span class="elsevierStyleSup">29</span></a> Our group also reported that patients with mild-to-moderate chronic heart failure treated with low-dose aspirin had a four-fold higher urinary excretion of ATL compared to untreated patients&#46;<a class="elsevierStyleCrossRef" href="#bib0590"><span class="elsevierStyleSup">31</span></a> Of note&#44; it has recently been shown that LXs and ATL promote reverse cholesterol transport&#44; thus suggesting that these SPMs may be promising therapeutic allies in cardiovascular disease prevention&#46;<a class="elsevierStyleCrossRefs" href="#bib0595"><span class="elsevierStyleSup">32&#44;33</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0275" class="elsevierStylePara elsevierViewall">Aspirin-acetylated COX-2 also triggers the production of other SPMs from omega-3 fatty acids&#46; Aspirin-triggered D-series Rvs and aspirin-triggered PDs are generated from docosahexaenoic acid&#44; while E-series Rvs are produced from eicosapentaenoic acid &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#41;&#46; These SPMs also exert anti-inflammatory and pro-resolving effects&#44; as well as protective effects on redox status and vascular reactivity&#46;<a class="elsevierStyleCrossRef" href="#bib0565"><span class="elsevierStyleSup">26</span></a></p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Aspirin and redox status</span><p id="par0280" class="elsevierStylePara elsevierViewall">Oxidative stress contributes to the pathogenesis of hypertension&#46;<a class="elsevierStyleCrossRefs" href="#bib0605"><span class="elsevierStyleSup">34&#8211;39</span></a> Given the interplay between inflammation and oxidative stress&#44;<a class="elsevierStyleCrossRef" href="#bib0635"><span class="elsevierStyleSup">40</span></a> it has been suggested that aspirin might have antioxidant properties that account for its cardiovascular benefits&#46; Wu et al&#46; observed that treatment with aspirin for 12 days significantly dose-dependently &#40;10-100 mg&#47;kg&#47;day&#41; reduced vascular superoxide &#40;O<span class="elsevierStyleInf">2</span><span class="elsevierStyleGlyphrad"></span><span class="elsevierStyleSup">&#8722;</span>&#41; production by lowering nicotinamide adenine dinucleotide phosphate &#40;NADPH&#41; oxidase activity in normotensive Wistar-Kyoto rats &#40;WKY&#41; and spontaneously hypertensive rats &#40;SHR&#41;&#46; Aspirin also restored acetylcholine-induced vasorelaxation in aortic rings from SHR&#44; but not from WKY&#46; In Sprague Dawley &#40;SD&#41; rats&#44; aspirin also inhibited angiotensin II &#40;Ang II&#41;-induced O<span class="elsevierStyleInf">2</span><span class="elsevierStyleGlyphrad"></span><span class="elsevierStyleSup">&#8722;</span> generation and attenuated the progression of hypertension&#46; Furthermore&#44; long-term treatment initiated in normotensive young SHR attenuated the development of hypertension&#44; but did not alter BP in young WKY or in adult SHR&#46;<a class="elsevierStyleCrossRef" href="#bib0640"><span class="elsevierStyleSup">41</span></a> Wu et al&#46; further demonstrated that treatment of SD rats with aspirin &#40;100 mg&#47;kg&#47;day for 12 days&#41; prevented Ang II-induced production of O<span class="elsevierStyleInf">2</span><span class="elsevierStyleGlyphrad"></span><span class="elsevierStyleSup">&#8722;</span> in cardiovascular tissues&#44; as well as O<span class="elsevierStyleInf">2</span><span class="elsevierStyleGlyphrad"></span><span class="elsevierStyleSup">&#8722;</span> and protein synthesis in cultured smooth muscle cells &#40;SMC&#41;&#46; It also prevented Ang II-induced hypertension and cardiac hypertrophy&#46; In contrast&#44; other NSAIDs failed to prevent Ang II-induced effects in vivo&#46;<a class="elsevierStyleCrossRef" href="#bib0645"><span class="elsevierStyleSup">42</span></a></p><p id="par0285" class="elsevierStylePara elsevierViewall">In cultured mice cardiac fibroblasts&#44; pretreatment with aspirin or salicylic acid in therapeutically relevant concentrations suppressed Ang II-induced NADPH oxidase expression&#44; ROS generation and activation of the transcription factor nuclear factor-kappa B &#40;NF-&#954;B&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0650"><span class="elsevierStyleSup">43</span></a></p><p id="par0290" class="elsevierStylePara elsevierViewall">Of note&#44; ATL also exerts protective effects on redox status&#46; In endothelial cells&#44; treatment with ATL blocked NADPH oxidase-mediated ROS production and increased the expression of the antioxidant molecule heme-oxygenase-1&#46;<a class="elsevierStyleCrossRefs" href="#bib0655"><span class="elsevierStyleSup">44&#44;45</span></a> ATL also inhibited ROS generation in leukocytes&#46;<a class="elsevierStyleCrossRefs" href="#bib0665"><span class="elsevierStyleSup">46&#44;47</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Aspirin and vascular tone</span><p id="par0295" class="elsevierStylePara elsevierViewall">Vascular tone is a determinant of peripheral resistance and consequently of BP&#46; Aspirin and salicylates may lower BP through a COX-independent mechanism involving the inhibition of a non-receptor tyrosine kinase&#44; proline-rich tyrosine kinase 2 &#40;PYK2&#41;&#44; in vascular SMCs&#46;<a class="elsevierStyleCrossRefs" href="#bib0675"><span class="elsevierStyleSup">48&#44;49</span></a> PYK2 is activated by various physiological stimuli including Ang II&#44; and seems to be essential for RhoA&#47;Rho kinase activation&#44; which is critical for calcium sensitization of vascular smooth muscle and appears to be increased in hypertension&#46;<a class="elsevierStyleCrossRefs" href="#bib0675"><span class="elsevierStyleSup">48&#44;50</span></a> Both aspirin and sodium salicylate relaxed preconstricted vessels by inhibiting PYK2-mediated RhoA&#47;Rho-kinase activation&#46; This occurred at higher concentrations than those necessary to inhibit COX&#46;<a class="elsevierStyleCrossRef" href="#bib0675"><span class="elsevierStyleSup">48</span></a></p><p id="par0300" class="elsevierStylePara elsevierViewall">Exploratory clinical trials have also suggested that low-dose aspirin improves endothelium-dependent vasodilation<a class="elsevierStyleCrossRefs" href="#bib0690"><span class="elsevierStyleSup">51&#8211;53</span></a> and it has therefore been hypothesized that aspirin might stimulate the release of NO from the vascular endothelium&#46;<a class="elsevierStyleCrossRef" href="#bib0705"><span class="elsevierStyleSup">54</span></a> Taubert et al&#46; demonstrated that low concentrations of aspirin elicited the release of NO from vascular endothelium and increased the activity of endothelial NO synthase &#40;eNOS&#41;&#46; This effect appears to be independent of COX but related to direct acetylation of eNOS&#44; and seems to be selective for aspirin since salicylate and indomethacin failed to modulate NO release&#46; Additionally&#44; higher aspirin concentrations scavenged O<span class="elsevierStyleInf">2</span><span class="elsevierStyleGlyphrad"></span><span class="elsevierStyleSup">&#8722;</span>&#44; thus preventing NO degradation&#46;<a class="elsevierStyleCrossRef" href="#bib0705"><span class="elsevierStyleSup">54</span></a></p><p id="par0305" class="elsevierStylePara elsevierViewall">The major protective effects of aspirin at low and medium&#47;high doses are summarized in <a class="elsevierStyleCrossRefs" href="#fig0015">Figures 3 and 4</a>&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Aspirin and blood pressure&#58; studies in experimental models of hypertension</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Effects when used alone</span><p id="par0310" class="elsevierStylePara elsevierViewall">The BP effects of aspirin were studied in two models of renovascular hypertension&#58; in one kidney&#44; one clip &#40;1K1C&#41;-hypertensive rats&#44; and in two kidney&#44; one clip &#40;2K1C&#41;-hypertensive rats&#46; Male SD rats were treated twice a day with aspirin 100 mg&#47;kg or vehicle and&#44; four days after beginning treatment&#44; their left renal artery was clipped &#40;2K1C rat model&#41;&#46; In another group&#44; besides left renal artery clipping&#44; the right kidney was also removed in all animals &#40;1K1C rat model&#41;&#46; BP was measured three weeks after surgery&#46; In comparison with vehicle-treated 2K1C rats&#44; aspirin-treated 2K1C rats exhibited higher BP values &#40;160 mmHg vs&#46; 140 mmHg&#44; p&#60;0&#46;05&#41;&#46; Interestingly&#44; aspirin treatment attenuated the BP increase in 1K1C rats &#40;153 mmHg vs&#46; 208 mmHg&#44; p&#60;0&#46;05&#41;&#46; Since 1K1C and 2K1C rats displayed different profiles in response to AA administration&#44; with 1K1C rats exhibiting an enhanced vasodepressor response to AA&#44; the authors suggested that aspirin decreases BP in hypertensive rats with increased activity of the COX pathway and raises BP in hypertensive rats that have a &#8216;normal&#8217; COX pathway&#46;<a class="elsevierStyleCrossRef" href="#bib0710"><span class="elsevierStyleSup">55</span></a></p><p id="par0315" class="elsevierStylePara elsevierViewall">Tuttle et al&#46; also assessed the antihypertensive effect of aspirin in SHR and WKY&#46; They first demonstrated that prolonged administration of aspirin &#40;100 mg&#47;kg&#47;daily&#41; to young SHR prevents the development of hypertension&#46;<a class="elsevierStyleCrossRef" href="#bib0715"><span class="elsevierStyleSup">56</span></a> Since aspirin loses its antihypertensive effect in adult SHR&#44; they investigated whether the loss of aspirin&#39;s effect on BP was associated with aging or with the duration of exposure to aspirin treatment&#46; A loss of aspirin&#39;s antihypertensive effect was found in all treated groups when SHR and WKY reached 110 days of age&#46; Furthermore&#44; since changes in PGF<span class="elsevierStyleInf">2</span>&#945;&#44; used as an index of COX activity&#44; did not parallel the BP alterations&#44; the authors assumed that the age of the animal&#44; and not a change in enzymatic activity or process over time&#44; was responsible for the loss of aspirin&#39;s antihypertensive effect&#46;<a class="elsevierStyleCrossRef" href="#bib0715"><span class="elsevierStyleSup">56</span></a> Similar results were obtained by Wu et al&#46;&#44; who observed significant attenuation of the development of hypertension in young SHR treated with aspirin &#40;100 mg&#47;kg&#47;day for 53 days&#41; but not in older aspirin-treated SHR or WKY&#46;<a class="elsevierStyleCrossRef" href="#bib0640"><span class="elsevierStyleSup">41</span></a> Nevertheless&#44; aspirin treatment significantly reduced aortic O<span class="elsevierStyleInf">2</span><span class="elsevierStyleGlyphrad"></span><span class="elsevierStyleSup">&#8722;</span> production in both old SHR and WKY&#46;<a class="elsevierStyleCrossRef" href="#bib0640"><span class="elsevierStyleSup">41</span></a></p><p id="par0320" class="elsevierStylePara elsevierViewall">The effect of aspirin on BP in SHR also appears to depend on baseline systolic BP &#40;SBP&#41; values&#46; In four-to-six-month old SHR&#44; a three-day treatment with aspirin &#40;100 mg&#47;kg&#47;day&#41; reduced SBP in the SHR group exhibiting SBP values above 161 mmHg before treatment&#46; In contrast&#44; in other SHR with baseline SBP below 160 mmHg&#44; aspirin significantly increased SBP&#44; and this elevation was more marked in SHR that had baseline normotensive SBP values&#46; Although the authors found no differences in the aortic production of TXA<span class="elsevierStyleInf">2</span> and PGI<span class="elsevierStyleInf">2</span>&#44; they speculated that the BP effects of aspirin were caused by inhibiting production of vasoconstrictor or vasodilator prostanoids&#46;<a class="elsevierStyleCrossRef" href="#bib0720"><span class="elsevierStyleSup">57</span></a></p><p id="par0325" class="elsevierStylePara elsevierViewall">In Ang II-infused rats&#44; concurrent aspirin treatment &#40;100 mg&#47;kg&#47;day for 12-14 days&#41; completely prevented Ang II-induced production of O<span class="elsevierStyleInf">2</span><span class="elsevierStyleGlyphrad"></span><span class="elsevierStyleSup">&#8722;</span> in cardiovascular tissues&#44; BP rise and cardiac hypertrophy&#46; These effects were not shared by other NSAIDs&#46;<a class="elsevierStyleCrossRef" href="#bib0645"><span class="elsevierStyleSup">42</span></a> When aspirin was given to Ang II-infused rats after the establishment of hypertension&#44; BP was significantly reduced after three days of treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0645"><span class="elsevierStyleSup">42</span></a> In chronically glucose-fed rats with elevated BP&#44; treatment with aspirin &#40;100 mg&#47;kg&#47;day for three weeks&#41; also prevented rises in SBP&#44; glucose levels and aortic O<span class="elsevierStyleInf">2</span><span class="elsevierStyleGlyphrad"></span><span class="elsevierStyleSup">&#8722;</span> production&#44; and attenuated insulin resistance&#46;<a class="elsevierStyleCrossRef" href="#bib0725"><span class="elsevierStyleSup">58</span></a></p><p id="par0330" class="elsevierStylePara elsevierViewall">The aspirin dose &#40;100 mg&#47;kg&#41; used in these studies is high&#44; being equivalent to a 1-g dose for a 70-kg man&#46; Nevertheless&#44; a lower dose &#40;10 mg&#47;kg&#47;day&#41;&#44; which would be equivalent to 100 mg&#47;day in a man&#44; was shown to significantly reduce vascular O<span class="elsevierStyleInf">2</span><span class="elsevierStyleGlyphrad"></span><span class="elsevierStyleSup">&#8722;</span> production&#46;<a class="elsevierStyleCrossRef" href="#bib0645"><span class="elsevierStyleSup">42</span></a> These antioxidative properties may account for the cardiovascular benefits of low-dose aspirin&#46;</p><p id="par0335" class="elsevierStylePara elsevierViewall">The impact of lower aspirin doses on BP has been tested in some studies&#46; In young male SHR&#44; the administration of aspirin &#40;10 mg&#47;kg&#41; twice a week for 10 weeks had no effect on SBP&#46;<a class="elsevierStyleCrossRefs" href="#bib0730"><span class="elsevierStyleSup">59&#44;60</span></a> In male Wistar rats&#44; 50 mg&#47;kg aspirin elicited a pressor response that was markedly enhanced by pretreatment with celecoxib&#44; a COX-2 inhibitor&#44; or with zileuton&#44; a 5-LOX inhibitor&#44; or with Boc-2&#44; a LXA<span class="elsevierStyleInf">4</span> receptor antagonist&#46;<a class="elsevierStyleCrossRef" href="#bib0585"><span class="elsevierStyleSup">30</span></a> Furthermore&#44; aspirin increased the serum concentration of ATL 20-fold and the administration of LXA<span class="elsevierStyleInf">4</span> alone significantly decreased BP&#46; Thus&#44; the formation of ATL attenuates the pressor response to aspirin&#44; and drugs that inhibit ATL production enhance the aspirin-induced BP rise&#46;<a class="elsevierStyleCrossRef" href="#bib0585"><span class="elsevierStyleSup">30</span></a> In another study&#44; treatment with aspirin &#40;53&#46;5 mg&#47;kg&#47;day&#41; for seven days did not alter BP in male Wistar rats but significantly reduced BP in stroke-prone SHR compared to vehicle-treated animals&#46;<a class="elsevierStyleCrossRef" href="#bib0740"><span class="elsevierStyleSup">61</span></a> Our group recently assessed the effect of low-dose aspirin &#40;10 mg&#47;kg&#47;day for eight days&#41; alone or in combination with losartan in male WKY and SHR&#46; Regarding the effect of aspirin alone&#44; no significant changes were observed in SBP of WKY or SHR compared to their respective controls&#46;<a class="elsevierStyleCrossRef" href="#bib0745"><span class="elsevierStyleSup">62</span></a> Recently&#44; another study also confirmed the lack of effect of low-dose aspirin &#40;10 mg&#47;kg&#47;day for seven days&#41; on the BP of normotensive WKY&#46;<a class="elsevierStyleCrossRef" href="#bib0750"><span class="elsevierStyleSup">63</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Effects when used in combination with other antihypertensive drugs</span><p id="par0340" class="elsevierStylePara elsevierViewall">The impact on BP of the combination of aspirin with antihypertensive drugs has been little studied&#46; Tuttle et al&#46; studied the antihypertensive efficacy of the BB metoprolol&#44; aspirin &#40;75-100 mg&#47;kg&#47;day&#41;&#44; and their combination for 56 days&#44; in young SHR and WKY&#46; Treatment with metoprolol or aspirin alone prevented BP rise in both WKY and SHR&#46; In contrast&#44; when the drugs were co-administered&#44; a loss of the antihypertensive effect was observed in SHR but not in WKY&#46; Renal PGs were also measured after 56 days of treatment&#46; Whereas renal PG content was higher in older SHR than in age-matched WKY&#44; lower levels were found in SHR receiving aspirin or metoprolol&#46; SHR treated with both drugs also exhibited reduced renal PG content&#44; despite the loss of antihypertensive efficacy&#46; The authors concluded that aspirin and metoprolol attenuate each other&#39;s antihypertensive effect&#44; but could not explain the underlying mechanism based on the changes observed in renal PGs&#46;<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">11</span></a></p><p id="par0345" class="elsevierStylePara elsevierViewall">Our group assessed the effects of combined treatment with low-dose aspirin &#40;10 mg&#47;kg&#47;day for eight days&#41; and the ARB losartan in male SHR and WKY&#46; Although aspirin treatment did not modify the antihypertensive effect of losartan in WKY&#44; it significantly improved the BP-lowering efficacy of losartan in SHR&#46; This effect was associated with a significant reduction in renal COX-2 expression and in the production of vasoconstrictive eicosanoids&#44; compared to SHR treated with losartan alone&#46;<a class="elsevierStyleCrossRefs" href="#bib0745"><span class="elsevierStyleSup">62&#44;64</span></a></p><p id="par0350" class="elsevierStylePara elsevierViewall">The interaction between aspirin and ACEIs was studied in SHR and in rats with methylprednisolone-induced hypertension&#46; In male SHR&#44; treatment with aspirin &#40;200mg&#47;kg&#47;day for seven days&#41; did not alter the antihypertensive effect of captopril&#44; although it markedly inhibited the formation of vasodilator prostanoids&#46; Thus&#44; these prostanoids do not appear to contribute to the antihypertensive effect of captopril in SHR&#46;<a class="elsevierStyleCrossRef" href="#bib0760"><span class="elsevierStyleSup">65</span></a> However&#44; in another study in older SHR&#44; combined treatment with captopril and aspirin &#40;200 mg&#47;kg&#47;day&#41; for seven days enhanced the antihypertensive effect of captopril&#44; apparently by inducing an increase in diuresis&#46; The inhibition of renal PG excretion by aspirin was a transient effect and it was concluded that the enhancement of captopril&#39;s antihypertensive efficacy by aspirin was independent of renal PG excretion&#46;<a class="elsevierStyleCrossRef" href="#bib0765"><span class="elsevierStyleSup">66</span></a> In male Wistar rats with methylprednisolone-induced hypertension&#44; treatment with 25 mg&#47;kg&#47;day or 100 mg&#47;kg&#47;day aspirin did not modify the hypotensive effect of lisinopril&#46; However&#44; cardiac and renal degenerative changes were found even with the lower aspirin dose&#44; and the combination of the higher aspirin dose and lisinopril was associated with a significant increase in mortality compared to hypertensive rats treated with lisinopril alone&#46;<a class="elsevierStyleCrossRef" href="#bib0770"><span class="elsevierStyleSup">67</span></a> A summary of these studies is presented in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Aspirin and blood pressure&#58; studies in humans</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Aspirin and blood pressure in healthy individuals</span><p id="par0355" class="elsevierStylePara elsevierViewall">The influence of aspirin on BP in healthy subjects was investigated in a study designed to assess the effects of captopril&#44; aspirin and the combination of both drugs on BP and on the excretion of prostanoids&#44; nitrates and cyclic guanosine monophosphate &#40;cGMP&#41;&#46; A crossover trial was performed in 13 healthy females aged 24&#46;9&#177;0&#46;5 years who were randomized to receive captopril &#40;25 mg twice a day&#41;&#44; aspirin &#40;100 mg&#47;day&#41; or both drugs for one week&#44; separated by a two-week washout&#46; Aspirin did not change BP when given alone and did not modulate the hypotensive effect of captopril when co-administered&#46; Urinary excretion of PGI<span class="elsevierStyleInf">2</span> metabolite&#44; PGE<span class="elsevierStyleInf">2</span>&#44; nitrate and cGMP was not altered by either treatment but aspirin significantly reduced the excretion of TXA<span class="elsevierStyleInf">2</span> metabolite&#44; when given alone or in combination with captopril&#46;<a class="elsevierStyleCrossRef" href="#bib0775"><span class="elsevierStyleSup">68</span></a></p><p id="par0360" class="elsevierStylePara elsevierViewall">Hermida et al&#46; investigated the administration time- and dose-dependent effects of aspirin on BP in healthy individuals&#46; In their first study&#44; 55 healthy subjects aged 20&#46;9&#177;1&#46;8 years were randomized to receive aspirin &#40;500 mg&#47;day&#41; for one week on awakening &#40;n&#61;18&#41;&#44; during the afternoon &#40;n&#61;26&#41; or at bedtime &#40;n&#61;11&#41;&#46; There was a significant reduction in BP only when aspirin was administered during the afternoon&#46;<a class="elsevierStyleCrossRef" href="#bib0780"><span class="elsevierStyleSup">69</span></a> The same authors also conducted a double-blind&#44; randomized clinical trial with 73 healthy participants &#40;21&#46;3&#177;0&#46;3 years of age&#41; assigned to one of six groups defined according to placebo&#47;aspirin dose &#40;100 or 500 mg&#47;day&#41; for one week and to the circadian time of administration &#40;awakening&#44; afternoon and bedtime&#41;&#46; In subjects receiving 500 mg aspirin&#44; there was a small &#40;approximately 2 mmHg&#41; but significant reduction in SBP and diastolic blood pressure &#40;DBP&#41; when aspirin was given in the afternoon&#46; Treatment with the lower dose in the afternoon elicited a significant SBP and DBP reduction&#44; comparable to that obtained with 500 mg aspirin administered at the same time&#46; However&#44; the BP reduction was larger when 100 mg aspirin was given at bedtime&#46; The higher impact on BP for 100 mg aspirin compared to 500 mg may be related to the selective inhibition of TXA<span class="elsevierStyleInf">2</span> but not PGI<span class="elsevierStyleInf">2</span> with the lower dose&#46; The time dependency of BP reduction by aspirin could be due to circadian rhythms in circulating platelets&#44; platelet aggregation&#44; clotting and fibrinolytic inhibitors&#44; and also in aspirin&#39;s inhibition of platelet aggregation&#46;<a class="elsevierStyleCrossRef" href="#bib0785"><span class="elsevierStyleSup">70</span></a></p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Aspirin and blood pressure in untreated hypertensive patients</span><p id="par0365" class="elsevierStylePara elsevierViewall">Hermida et al&#46; also assessed the administration time-dependency of the effect of 100 mg&#47;day aspirin for one week on BP reduction in untreated hypertensive subjects&#46; This was performed in 18 volunteers aged 21&#46;8&#177;0&#46;4 years&#44; recently diagnosed with mild hypertension and untreated for hypertension&#46; Aspirin significantly decreased BP when administered in the afternoon and at bedtime&#44; but the effect was larger for bedtime administration&#46;<a class="elsevierStyleCrossRef" href="#bib0785"><span class="elsevierStyleSup">70</span></a> The same authors also conducted a trial in 100 untreated volunteers with mild &#40;grade 1&#41; essential hypertension&#44; aged 42&#46;5&#177;11&#46;6 years&#44; who were randomly allocated to three groups to take hygienic-dietary recommendations &#40;HDR&#41; &#40;n&#61;50&#41;&#44; HDR plus aspirin &#40;100 mg&#47;day&#41; on awakening &#40;n&#61;24&#41; or HDR plus aspirin &#40;100 mg&#47;day&#41; before bedtime &#40;n&#61;26&#41; for three months&#46; Essentially&#44; in the group that received aspirin before bedtime&#44; but not in the other groups&#44; there were significant reductions in SBP and DBP measured by conventional methods and by ambulatory blood pressure measurement &#40;ABPM&#41;&#46; Although the mechanisms responsible for this decrease have not been elucidated&#44; the authors speculate that circadian rhythms in TXA<span class="elsevierStyleInf">2</span> production and in plasma renin activity &#40;PRA&#41; could account for the BP lowering effect of aspirin&#46;<a class="elsevierStyleCrossRef" href="#bib0790"><span class="elsevierStyleSup">71</span></a> Hermida et al&#46; also conducted a similar study involving a larger sample of 328 untreated grade 1 hypertensive patients aged 44&#46;0&#177;12&#46;6 years&#46; These subjects were randomly distributed to the same groups described above &#40;HDR&#44; n&#61;169&#59; HDR plus aspirin 100 mg&#47;day on awakening&#44; n&#61;77&#59; HDR plus aspirin 100 mg&#47;day before bedtime&#44; n&#61;82&#41;&#46; The results obtained corroborated the previously described reduction of SBP and DBP values on ABPM and conventional measurement in the group receiving low-dose aspirin at bedtime&#46;<a class="elsevierStyleCrossRef" href="#bib0795"><span class="elsevierStyleSup">72</span></a> They further compared the chronobiological impact of aspirin on BP in dipper and non-dipper subjects with untreated grade 1 hypertension &#40;n&#61;257&#41; randomized to receive aspirin &#40;100 mg&#47;day&#41; on awakening &#40;n&#61;126&#44; 80 dipper and 46 non-dipper&#41; or at bedtime &#40;n&#61;131&#44; 83 dipper and 48 non-dipper&#41; for three months&#46; This study again confirmed that aspirin given at bedtime&#44; but not on awakening&#44; significantly reduced 24-hour SBP and DBP&#46; Of note&#44; aspirin administered at bedtime induced a two-fold higher decrease in nocturnal BP in non-dipper patients compared to dipper patients&#46;<a class="elsevierStyleCrossRef" href="#bib0800"><span class="elsevierStyleSup">73</span></a> Interestingly&#44; in another study they also demonstrated the existence of gender differences in BP response to aspirin administration&#46; This trial included 130 men and 186 women with untreated grade 1 hypertension who were randomly assigned to take aspirin 100 mg&#47;day on awakening or at bedtime for three months&#46;<a class="elsevierStyleCrossRef" href="#bib0805"><span class="elsevierStyleSup">74</span></a> When aspirin was administered on awakening&#44; BP was not altered in men but was slightly increased in women&#46; In contrast&#44; when aspirin was given at bedtime&#44; BP values were significantly decreased in both men and women&#46; This reduction was significantly larger in women than in men&#44; and gender differences in BP were greater during night-time rest&#46;<a class="elsevierStyleCrossRef" href="#bib0805"><span class="elsevierStyleSup">74</span></a></p><p id="par0370" class="elsevierStylePara elsevierViewall">Magagna et al&#46; also assessed the influence of 100 mg&#47;day aspirin on BP control in untreated borderline or mild essential hypertensive subjects&#46; Ten patients aged 47&#46;9&#177;5&#46;1 years received aspirin &#40;100 mg&#47;day&#41; or placebo for four weeks&#46; Aspirin treatment did not modify BP in these patients but significantly reduced serum and urinary TXB<span class="elsevierStyleInf">2</span> and PRA&#46;<a class="elsevierStyleCrossRef" href="#bib0810"><span class="elsevierStyleSup">75</span></a> Although urinary excretion of PGI<span class="elsevierStyleInf">2</span> metabolite was not significantly altered by aspirin treatment&#44; the authors reported that it was slightly decreased and could have contributed to the reduction in PRA&#46;<a class="elsevierStyleCrossRef" href="#bib0810"><span class="elsevierStyleSup">75</span></a> The effect on BP of low-dose aspirin in untreated hypertensive patients was further studied by Snoep et al&#46; as a secondary endpoint in a crossover trial designed to assess the mechanisms underlying BP reduction when aspirin was given at bedtime&#46;<a class="elsevierStyleCrossRef" href="#bib0815"><span class="elsevierStyleSup">76</span></a> This trial included 16 untreated grade 1 hypertensive individuals aged 58&#46;4&#177;6&#46;8 years who were randomly allocated to one of two groups&#44; one receiving aspirin &#40;100 mg&#47;day&#41; at bedtime and placebo on awakening&#44; and the other receiving aspirin on awakening and placebo at bedtime&#44; for two weeks&#46; After a four-week washout interval&#44; patients again received aspirin and placebo for another two weeks&#44; in the reverse order of the first treatment period&#46; The results of this study indicate that aspirin intake at bedtime compared with the morning significantly reduced PRA over 24 hours&#44; as well as 24-hour urinary excretion of cortisol&#44; dopamine and noradrenaline&#46; The authors suggested that reduced activity of these pressor systems was a plausible explanation for the BP decrease when aspirin is given at night and the lack of effect detected when given in the morning&#46; Although in this study no significant reduction in 24-hour BP was observed when aspirin was given at bedtime&#44; the authors hypothesized that the treatment period was probably too short to translate the effects on BP regulating systems into effective BP reduction&#46; They also underlined that their study was not designed and powered to detect differences in BP response to timed administration of aspirin&#46;<a class="elsevierStyleCrossRef" href="#bib0815"><span class="elsevierStyleSup">76</span></a></p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Aspirin and blood pressure in subjects at elevated risk for developing hypertension</span><p id="par0375" class="elsevierStylePara elsevierViewall">In addition to these studies in subjects with mild hypertension&#44; Hermida et al&#46; also compared the BP effects of different administration times &#40;awakening&#44; afternoon or bedtime&#41; of low-dose aspirin &#40;100 mg&#47;day&#41; in pregnant women at higher risk for gestational hypertension or preeclampsia&#46;<a class="elsevierStyleCrossRefs" href="#bib0820"><span class="elsevierStyleSup">77&#8211;79</span></a> The results obtained in these trials corroborate previous findings in healthy and untreated mild hypertensive subjects&#44;<a class="elsevierStyleCrossRef" href="#bib0785"><span class="elsevierStyleSup">70</span></a> i&#46;e&#46;&#44; BP was significantly reduced when aspirin was administered in the afternoon and this effect was even greater when it was given at bedtime&#46; There was no significant change in BP when aspirin was administered on awakening&#46;<a class="elsevierStyleCrossRefs" href="#bib0820"><span class="elsevierStyleSup">77&#8211;79</span></a></p><p id="par0380" class="elsevierStylePara elsevierViewall">Similar results were obtained in another study by the same group involving 244 individuals aged 43&#46;0&#177;13&#46;0 years with prehypertension randomly distributed to one of three groups &#40;non-pharmacological recommendations&#59; the same recommendations and aspirin 100 mg&#47;day on awakening&#59; and the same recommendations and aspirin 100 mg&#47;day at bedtime&#41;&#46; Once again&#44; a significant BP reduction was observed only when aspirin was given at bedtime&#46;<a class="elsevierStyleCrossRef" href="#bib0835"><span class="elsevierStyleSup">80</span></a></p><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Aspirin and blood pressure in treated hypertensive patients</span><p id="par0385" class="elsevierStylePara elsevierViewall">The majority of small&#44; short-term trials have reported that low doses &#40;75-100 mg&#47;day&#41; of aspirin do not interfere with the BP lowering effect of ACEIs &#40;captopril&#44; enalapril&#41;&#44; ARBs &#40;losartan&#41;&#44; BBs &#40;atenolol&#41; and calcium antagonists &#40;nifedipine&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0485"><span class="elsevierStyleSup">10&#44;14&#44;19&#44;75&#44;81&#44;82</span></a> Regarding the interaction of low-dose aspirin and ACEIs&#44; although no change in the antihypertensive effect of ACEIs was detected&#44; significant reductions in serum and&#47;or urinary TXB<span class="elsevierStyleInf">2</span> were observed with combined treatment with aspirin compared with treatment with ACEIs alone&#46;<a class="elsevierStyleCrossRefs" href="#bib0505"><span class="elsevierStyleSup">14&#44;75&#44;81</span></a> Nevertheless&#44; no significant changes were observed in the urinary metabolite of PGI<span class="elsevierStyleInf">2</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0810"><span class="elsevierStyleSup">75</span></a> Studies assessing the effects of higher aspirin doses on the BP of patients treated with ACEIs have reported contradictory results&#46; While Guazzi et al&#46; showed that aspirin &#40;300 mg&#47;day&#41; induced an antagonistic effect on the action of enalapril&#44;<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">10</span></a> Nawarskas et al&#46; observed no significant changes in mean arterial pressure&#44; SBP or DBP in patients treated with aspirin &#40;325 mg&#41; and enalapril&#44; compared to enalapril alone&#46;<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">14</span></a> Furthermore&#44; Fisman et al&#46; reported that treatment with aspirin 500 mg&#47;day for one week did not influence BP control in hypertensive or in post-infarction patients receiving an ACEI&#46;<a class="elsevierStyleCrossRef" href="#bib0850"><span class="elsevierStyleSup">83</span></a> Also of note is the fact that combined treatment with aspirin &#40;100 and&#47;or 300 mg&#47;day&#41; and ACEIs reduced the ACEI-induced increased in PRA&#46;<a class="elsevierStyleCrossRefs" href="#bib0485"><span class="elsevierStyleSup">10&#44;75</span></a></p><p id="par0390" class="elsevierStylePara elsevierViewall">The interaction of aspirin with ARBs does not appear to negatively influence BP control&#46; No significant BP differences were observed when losartan was associated with aspirin therapy &#40;81 mg or 325 mg&#47;day&#41; for two weeks&#46;<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">14</span></a> Of note&#44; a post-hoc subgroup analysis of the Losartan Intervention For Endpoint reduction in hypertension &#40;LIFE&#41; study revealed that the combination of aspirin with losartan exerted greater cardiovascular protection than the combination of aspirin with atenolol&#44; despite similar BP reduction&#46;<a class="elsevierStyleCrossRef" href="#bib0510"><span class="elsevierStyleSup">15</span></a> Additionally&#44; a significant decrease in cardiovascular events was found in patients using aspirin plus losartan&#44; compared with losartan alone&#46;<a class="elsevierStyleCrossRef" href="#bib0510"><span class="elsevierStyleSup">15</span></a> Interestingly&#44; Prikryl et al&#46; showed that the addition of aspirin to telmisartan improved the effects of this ARB on BP&#44; heart rate&#44; intrarenal resistive index and ejection fraction&#46;<a class="elsevierStyleCrossRef" href="#bib0855"><span class="elsevierStyleSup">84</span></a></p><p id="par0395" class="elsevierStylePara elsevierViewall">There have also been large and medium- or long-term trials assessing the BP effects of aspirin in patients on antihypertensive monotherapy or combination therapy &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; Avanzini et al&#46; reported that there was no significant change in BP after addition of aspirin &#40;100 mg&#47;day&#41; to antihypertensive therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">13</span></a> Results from the Hypertension Optimal Treatment &#40;HOT&#41; randomized trial also revealed that there were no differences in achieved BP in patients randomized to aspirin or placebo&#46;<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">4</span></a> Importantly&#44; the combination of aspirin with antihypertensive treatment reduced the risk of acute myocardial infarction without increasing the risk of cerebral bleeding&#46;<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">4</span></a> Furthermore&#44; the BP values achieved&#44; the intensity of the antihypertensive regimen&#44; and the number and type of drugs used were very similar in aspirin and placebo patients&#44; not only in the overall HOT study population&#44; but in all subgroups&#46;<a class="elsevierStyleCrossRef" href="#bib0860"><span class="elsevierStyleSup">85</span></a> Of note&#44; Leinonen et al&#46; conducted a large observational study to assess the effect of aspirin treatment &#40;50-250 mg&#47;day&#41; on BP of hypertensive patients receiving antihypertensive monotherapy or combination therapy and observed that aspirin reduced DBP regardless of the antihypertensive therapeutic scheme&#46;<a class="elsevierStyleCrossRef" href="#bib0545"><span class="elsevierStyleSup">22</span></a></p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0400" class="elsevierStylePara elsevierViewall">The chronotherapeutic effects of aspirin have also been investigated in treated hypertensive patients &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; The administration time-dependent effects of aspirin were assessed in patients with long-standing hypertension and treated with aspirin for cardiovascular prevention&#46; Hypertensive patients were randomly assigned to take aspirin &#40;75-160 mg&#47;day&#41; in the morning followed by aspirin in the evening&#44; or in the reverse order&#44; during two one-month periods&#44; with no washout period&#46; No differences were found in mean 24-hour SBP or DBP&#44; or in patients&#8217; dipper&#47;non-dipper status&#44; independently of aspirin administration time&#46;<a class="elsevierStyleCrossRef" href="#bib0865"><span class="elsevierStyleSup">86</span></a> The timing effect of aspirin dosing on BP was further studied in a recent crossover trial including patients taking low-dose aspirin for secondary cardiovascular disease prevention&#46; Subjects were randomized to receive aspirin on awakening then at bedtime&#44; or the reverse order&#44; during two three-month periods&#44; with no washout period&#46; No differences were found in mean 24-hour SBP or DBP when aspirin was administered at awakening or at bedtime&#46; However&#44; morning platelet reactivity was significantly reduced when aspirin was taken at bedtime&#46;<a class="elsevierStyleCrossRef" href="#bib0870"><span class="elsevierStyleSup">87</span></a> These results<a class="elsevierStyleCrossRefs" href="#bib0865"><span class="elsevierStyleSup">86&#44;87</span></a> contradict those observed for bedtime aspirin administration in patients with untreated mild hypertension or those at risk of developing hypertension&#44;<a class="elsevierStyleCrossRefs" href="#bib0785"><span class="elsevierStyleSup">70&#8211;73&#44;77&#8211;80</span></a> and may be explained by differences in study populations or by a weakened chronopharmacological effect of aspirin in patients taking this drug for a long time&#46;<a class="elsevierStyleCrossRefs" href="#bib0865"><span class="elsevierStyleSup">86&#44;87</span></a> A summary of studies assessing aspirin&#39;s effects in treated hypertensive patients is presented in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46;</p></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclusions</span><p id="par0405" class="elsevierStylePara elsevierViewall">Besides its well-known antithrombotic effect&#44; aspirin exerts protective effects on redox status and vascular reactivity and triggers the synthesis of SPMs from AA and omega-3 fatty acids&#44; which may account for its overall cardiovascular benefits&#46;</p><p id="par0410" class="elsevierStylePara elsevierViewall">Most studies assessing aspirin&#39;s effects on BP in experimental and human hypertension indicate that&#44; when used in low doses&#44; aspirin by itself does not affect BP values and does not counteract the BP-lowering efficacy of antihypertensive drugs&#46; Of note&#44; combined treatment with ARBs and aspirin appears to improve cardiovascular protection&#44; compared to ARBs alone&#46; Nevertheless&#44; experimental studies assessing aspirin&#39;s interaction with antihypertensive drugs are scarce and have done little to identify the mechanisms underlying its protective or deleterious effects&#46;</p><p id="par0415" class="elsevierStylePara elsevierViewall">In subjects with long-standing hypertension and treated with antihypertensive drugs&#44; the time of aspirin administration does not seem to affect BP control&#44; although bedtime intake might exert stronger protection against cardiovascular events due to its significant effect in lowering morning platelet reactivity&#46;</p><p id="par0420" class="elsevierStylePara elsevierViewall">In conclusion&#44; low doses of aspirin do not negatively influence BP control by antihypertensive drugs and appear to enhance cardiovascular protection when associated with ARBs&#46; Further studies are needed to elucidate the mechanisms responsible for these effects&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Funding</span><p id="par0425" class="elsevierStylePara elsevierViewall">This work was supported by FEDER funds via <span class="elsevierStyleGrantSponsor" id="gs1">COMPETE</span> and by national funds through <span class="elsevierStyleGrantSponsor" id="gs2">FCT</span> &#8211; Portuguese Foundation for Science and Technology &#40;project grants&#58; <span class="elsevierStyleGrantNumber" refid="gs2">PTDC&#47;SAU-TOX&#47;114166&#47;2009</span> and <span class="elsevierStyleGrantNumber" refid="gs2">EXPL&#47;IVC-PEC&#47;1302&#47;2013</span>&#41;&#46; Teresa Sousa was also funded by FCT &#40;<span class="elsevierStyleGrantNumber" refid="gs2">SFRH&#47;BPD&#47;112005&#47;2015</span>&#41;&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Ethical disclosures</span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Protection of human and animal subjects</span><p id="par0430" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Confidentiality of data</span><p id="par0435" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Right to privacy and informed consent</span><p id="par0440" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflicts of interest</span><p id="par0445" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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            0 => "Aspirina"
            1 => "A&#231;&#245;es farmacol&#243;gicas"
            2 => "Press&#227;o arterial"
            3 => "Hipertens&#227;o"
            4 => "F&#225;rmacos anti-hipertensores"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Arterial hypertension is a major risk factor for cardiovascular and renal events&#46; Lowering blood pressure is thus an important strategy for reducing morbidity and mortality&#46; Since low-dose aspirin is a cornerstone in the prevention of adverse cardiovascular outcomes&#44; combined treatment with aspirin and antihypertensive drugs is very common&#46; However&#44; the impact of aspirin therapy on blood pressure control remains a subject of intense debate&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Recent data suggest that the cardioprotective action of aspirin extends beyond its well-known antithrombotic effect&#46; Aspirin has been shown to trigger the synthesis of specialized pro-resolving lipid mediators from arachidonic acid and omega-3 fatty acids&#46; These novel anti-inflammatory and pro-resolving mediators actively stimulate the resolution of inflammation and tissue regeneration&#46; Additionally&#44; they may contribute to other protective effects on redox status and vascular reactivity that have also been attributed to aspirin&#46; Of note&#44; aspirin has been shown to improve vasodilation through cyclooxygenase-independent mechanisms&#46; On the other hand&#44; higher aspirin doses have been reported to exert a negative impact on blood pressure due to inhibition of cyclooxygenase-2 activity&#44; which reduces renal blood flow&#44; glomerular filtration rate and sodium and water excretion&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">This review aims to provide an overview of the effects of aspirin on blood pressure and the underlying mechanisms&#44; focusing on the interaction between aspirin and antihypertensive drugs&#46; Studies in both experimental and human hypertension are presented&#46;</p></span>"
      ]
      "pt" => array:2 [
        "titulo" => "Resumo"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A hipertens&#227;o arterial representa um fator de risco <span class="elsevierStyleItalic">major</span> para eventos cardiovasculares e renais&#46; Por esse motivo&#44; a redu&#231;&#227;o da press&#227;o arterial &#233; uma estrat&#233;gia importante para a diminui&#231;&#227;o da morbilidade e mortalidade&#46; Como a aspirina em dose baixa constitui a terap&#234;utica base na preven&#231;&#227;o de eventos cardiovasculares&#44; a sua associa&#231;&#227;o com f&#225;rmacos anti-hipertensores &#233; muito comum&#46; No entanto&#44; o impacto da aspirina no controlo da press&#227;o arterial permanece um tema de intensa discuss&#227;o&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Estudos recentes sugerem que a a&#231;&#227;o cardioprotetora da aspirina n&#227;o est&#225; limitada ao seu conhecido efeito antitromb&#243;tico&#46; A aspirina ativa a s&#237;ntese de mediadores pr&#243;-resolutivos especializados a partir do &#225;cido araquid&#243;nico e de &#225;cidos gordos &#243;mega-3&#46; Estes novos mediadores anti-inflamat&#243;rios e pr&#243;-resolutivos estimulam ativamente a resolu&#231;&#227;o da inflama&#231;&#227;o e a regenera&#231;&#227;o tecidual&#46; Adicionalmente&#44; poder&#227;o contribuir para os efeitos protetores no estado <span class="elsevierStyleItalic">redox</span> e na reatividade vascular que t&#234;m sido atribu&#237;dos &#224; aspirina&#46; &#201; de sublinhar que a aspirina parece tamb&#233;m melhorar a vasodilata&#231;&#227;o por mecanismos independentes da inibi&#231;&#227;o da cicloxigenase&#46; Por outro lado&#44; o uso de aspirina em doses altas parece exercer um efeito negativo na press&#227;o arterial devido &#224; inibi&#231;&#227;o da atividade da cicloxigenase-2 e consequente redu&#231;&#227;o do fluxo sangu&#237;neo renal&#44; da taxa de filtra&#231;&#227;o glomerular e da excre&#231;&#227;o de s&#243;dio e &#225;gua&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Este artigo pretende rever os efeitos da aspirina na press&#227;o arterial e mecanismos subjacentes&#44; com enfoque na intera&#231;&#227;o entre a aspirina e os f&#225;rmacos anti-hipertensores&#46; S&#227;o apresentados estudos na hipertens&#227;o experimental e humana&#46;</p></span>"
      ]
    ]
    "nomenclatura" => array:1 [
      0 => array:3 [
        "identificador" => "nom0005"
        "titulo" => "<span class="elsevierStyleSectionTitle" id="sect0025">List of abbreviations</span>"
        "listaDefinicion" => array:1 [
          0 => array:1 [
            "definicion" => array:55 [
              0 => array:2 [
                "termino" => "15-epi-LXA4"
                "descripcion" => "<p id="par0005" class="elsevierStylePara elsevierViewall">15R-epimeric lipoxin A4</p>"
              ]
              1 => array:2 [
                "termino" => "15-epi-LXB4"
                "descripcion" => "<p id="par0010" class="elsevierStylePara elsevierViewall">15R-epimeric lipoxin B4</p>"
              ]
              2 => array:2 [
                "termino" => "15-epi-LXs"
                "descripcion" => "<p id="par0015" class="elsevierStylePara elsevierViewall">15-epi-lipoxins</p>"
              ]
              3 => array:2 [
                "termino" => "15R-HETE"
                "descripcion" => "<p id="par0020" class="elsevierStylePara elsevierViewall">15&#40;R&#41;-hydroxyeicosatetraenoic acid</p>"
              ]
              4 => array:2 [
                "termino" => "17R-HDHA"
                "descripcion" => "<p id="par0025" class="elsevierStylePara elsevierViewall">17R-hydroxydocosahexaenoic acid</p>"
              ]
              5 => array:2 [
                "termino" => "18R-HETE"
                "descripcion" => "<p id="par0030" class="elsevierStylePara elsevierViewall">18R-hydroxyeicosapentaenoic acid</p>"
              ]
              6 => array:2 [
                "termino" => "5-LOX"
                "descripcion" => "<p id="par0035" class="elsevierStylePara elsevierViewall">5-lipoxygenase</p>"
              ]
              7 => array:2 [
                "termino" => "AA"
                "descripcion" => "<p id="par0040" class="elsevierStylePara elsevierViewall">arachidonic acid</p>"
              ]
              8 => array:2 [
                "termino" => "ABPM"
                "descripcion" => "<p id="par0045" class="elsevierStylePara elsevierViewall">ambulatory blood pressure measurement</p>"
              ]
              9 => array:2 [
                "termino" => "ACEI"
                "descripcion" => "<p id="par0050" class="elsevierStylePara elsevierViewall">angiotensin-converting enzyme inhibitors</p>"
              ]
              10 => array:2 [
                "termino" => "Ang II"
                "descripcion" => "<p id="par0055" class="elsevierStylePara elsevierViewall">angiotensin II</p>"
              ]
              11 => array:2 [
                "termino" => "ARB"
                "descripcion" => "<p id="par0060" class="elsevierStylePara elsevierViewall">angiotensin receptor blockers</p>"
              ]
              12 => array:2 [
                "termino" => "AT-PD"
                "descripcion" => "<p id="par0450" class="elsevierStylePara elsevierViewall">aspirin triggered protectin</p>"
              ]
              13 => array:2 [
                "termino" => "AT-RvD1"
                "descripcion" => "<p id="par0455" class="elsevierStylePara elsevierViewall">aspirin triggered resolvin D1</p>"
              ]
              14 => array:2 [
                "termino" => "AT-RvD2"
                "descripcion" => "<p id="par0460" class="elsevierStylePara elsevierViewall">aspirin triggered resolvin D2</p>"
              ]
              15 => array:2 [
                "termino" => "AT-RvD3"
                "descripcion" => "<p id="par0465" class="elsevierStylePara elsevierViewall">aspirin triggered resolvin D3</p>"
              ]
              16 => array:2 [
                "termino" => "AT-RvD4"
                "descripcion" => "<p id="par0470" class="elsevierStylePara elsevierViewall">aspirin triggered resolvin D4</p>"
              ]
              17 => array:2 [
                "termino" => "ATL"
                "descripcion" => "<p id="par0065" class="elsevierStylePara elsevierViewall">aspirin-triggered lipoxins</p>"
              ]
              18 => array:2 [
                "termino" => "BB"
                "descripcion" => "<p id="par0070" class="elsevierStylePara elsevierViewall">beta-blockers</p>"
              ]
              19 => array:2 [
                "termino" => "BP"
                "descripcion" => "<p id="par0475" class="elsevierStylePara elsevierViewall">blood pressure</p>"
              ]
              20 => array:2 [
                "termino" => "cGMP"
                "descripcion" => "<p id="par0075" class="elsevierStylePara elsevierViewall">cyclic guanosine monophosphate</p>"
              ]
              21 => array:2 [
                "termino" => "COX-1"
                "descripcion" => "<p id="par0080" class="elsevierStylePara elsevierViewall">cyclooxygenase-1</p>"
              ]
              22 => array:2 [
                "termino" => "COX-2"
                "descripcion" => "<p id="par0085" class="elsevierStylePara elsevierViewall">cyclooxygenase-2</p>"
              ]
              23 => array:2 [
                "termino" => "DBP"
                "descripcion" => "<p id="par0090" class="elsevierStylePara elsevierViewall">diastolic blood pressure</p>"
              ]
              24 => array:2 [
                "termino" => "DHA"
                "descripcion" => "<p id="par0095" class="elsevierStylePara elsevierViewall">docosahexaenoic acid</p>"
              ]
              25 => array:2 [
                "termino" => "eNOS"
                "descripcion" => "<p id="par0100" class="elsevierStylePara elsevierViewall">endothelial nitric oxide synthase</p>"
              ]
              26 => array:2 [
                "termino" => "EPA"
                "descripcion" => "<p id="par0105" class="elsevierStylePara elsevierViewall">eicosapentaenoic acid</p>"
              ]
              27 => array:2 [
                "termino" => "HDR"
                "descripcion" => "<p id="par0110" class="elsevierStylePara elsevierViewall">hygienic-dietary recommendations</p>"
              ]
              28 => array:2 [
                "termino" => "HOT"
                "descripcion" => "<p id="par0115" class="elsevierStylePara elsevierViewall">Hypertension Optimal Treatment</p>"
              ]
              29 => array:2 [
                "termino" => "LIFE"
                "descripcion" => "<p id="par0120" class="elsevierStylePara elsevierViewall">Losartan Intervention For Endpoint reduction in hypertension</p>"
              ]
              30 => array:2 [
                "termino" => "LOX"
                "descripcion" => "<p id="par0125" class="elsevierStylePara elsevierViewall">lipoxygenase</p>"
              ]
              31 => array:2 [
                "termino" => "LXs"
                "descripcion" => "<p id="par0130" class="elsevierStylePara elsevierViewall">lipoxins</p>"
              ]
              32 => array:2 [
                "termino" => "NADPH oxidase"
                "descripcion" => "<p id="par0135" class="elsevierStylePara elsevierViewall">nicotinamide adenine dinucleotide phosphate oxidase</p>"
              ]
              33 => array:2 [
                "termino" => "NF&#954;B"
                "descripcion" => "<p id="par0480" class="elsevierStylePara elsevierViewall">nuclear factor kappa B</p>"
              ]
              34 => array:2 [
                "termino" => "NO"
                "descripcion" => "<p id="par0140" class="elsevierStylePara elsevierViewall">nitric oxide</p>"
              ]
              35 => array:2 [
                "termino" => "NSAIDs"
                "descripcion" => "<p id="par0145" class="elsevierStylePara elsevierViewall">nonsteroidal anti-inflammatory drugs</p>"
              ]
              36 => array:2 [
                "termino" => "O<span class="elsevierStyleInf">2</span><span class="elsevierStyleGlyphrad"></span><span class="elsevierStyleSup">&#8722;</span>"
                "descripcion" => "<p id="par0150" class="elsevierStylePara elsevierViewall">superoxide</p>"
              ]
              37 => array:2 [
                "termino" => "PDs"
                "descripcion" => "<p id="par0155" class="elsevierStylePara elsevierViewall">protectins</p>"
              ]
              38 => array:2 [
                "termino" => "PGE2"
                "descripcion" => "<p id="par0160" class="elsevierStylePara elsevierViewall">prostaglandin E2</p>"
              ]
              39 => array:2 [
                "termino" => "PGI2"
                "descripcion" => "<p id="par0165" class="elsevierStylePara elsevierViewall">prostacyclin</p>"
              ]
              40 => array:2 [
                "termino" => "PGs"
                "descripcion" => "<p id="par0170" class="elsevierStylePara elsevierViewall">prostaglandins</p>"
              ]
              41 => array:2 [
                "termino" => "PRA"
                "descripcion" => "<p id="par0175" class="elsevierStylePara elsevierViewall">plasma renin activity</p>"
              ]
              42 => array:2 [
                "termino" => "PYK2"
                "descripcion" => "<p id="par0180" class="elsevierStylePara elsevierViewall">proline-rich tyrosine kinase 2</p>"
              ]
              43 => array:2 [
                "termino" => "ROS"
                "descripcion" => "<p id="par0185" class="elsevierStylePara elsevierViewall">reactive oxygen species</p>"
              ]
              44 => array:2 [
                "termino" => "RvE1"
                "descripcion" => "<p id="par0485" class="elsevierStylePara elsevierViewall">resolvin E1</p>"
              ]
              45 => array:2 [
                "termino" => "RvE2"
                "descripcion" => "<p id="par0490" class="elsevierStylePara elsevierViewall">resolvin E2</p>"
              ]
              46 => array:2 [
                "termino" => "Rvs"
                "descripcion" => "<p id="par0190" class="elsevierStylePara elsevierViewall">resolvins</p>"
              ]
              47 => array:2 [
                "termino" => "SBP"
                "descripcion" => "<p id="par0195" class="elsevierStylePara elsevierViewall">systolic blood pressure</p>"
              ]
              48 => array:2 [
                "termino" => "SHR"
                "descripcion" => "<p id="par0200" class="elsevierStylePara elsevierViewall">spontaneously hypertensive rats</p>"
              ]
              49 => array:2 [
                "termino" => "SD"
                "descripcion" => "<p id="par0205" class="elsevierStylePara elsevierViewall">Sprague Dawley</p>"
              ]
              50 => array:2 [
                "termino" => "SMC"
                "descripcion" => "<p id="par0210" class="elsevierStylePara elsevierViewall">smooth muscle cells</p>"
              ]
              51 => array:2 [
                "termino" => "SPMs"
                "descripcion" => "<p id="par0215" class="elsevierStylePara elsevierViewall">specialized pro-resolving lipid mediators</p>"
              ]
              52 => array:2 [
                "termino" => "TXA2"
                "descripcion" => "<p id="par0220" class="elsevierStylePara elsevierViewall">thromboxane A2</p>"
              ]
              53 => array:2 [
                "termino" => "TXB2"
                "descripcion" => "<p id="par0225" class="elsevierStylePara elsevierViewall">thromboxane B2</p>"
              ]
              54 => array:2 [
                "termino" => "WKY"
                "descripcion" => "<p id="par0230" class="elsevierStylePara elsevierViewall">Wistar-Kyoto rats</p>"
              ]
            ]
          ]
        ]
      ]
    ]
    "multimedia" => array:6 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1956
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Biosynthesis of aspirin-triggered lipoxins&#46; 5-LOX&#58; 5-lipoxygenase&#59; 15-epi-LXs&#58; 15-epi-lipoxins&#59; 15R-HETE&#58; 15R-hydroxyeicosatetraenoic acid&#59; AA&#58; arachidonic acid&#59; ATL&#58; aspirin-triggered lipoxins&#59; COX-2&#58; cyclooxygenase-2&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Biosynthesis of aspirin-triggered resolvins and protectin&#46; 5-LOX&#58; 5-lipoxygenase&#59; 17R-HDHA&#58; 17R-hydroxydocosahexaenoic acid&#59; 18R-HETE&#58; 18R-hydroxyeicosapentaenoic acid&#59; AT-RvD1&#58; aspirin-triggered resolvin D1&#59; AT-RvD2&#58; aspirin-triggered resolvin D2&#59; AT-RvD3&#58; aspirin-triggered resolvin D3&#59; AT-RvD4&#58; aspirin-triggered resolvin D4&#59; AT-PD&#58; aspirin-triggered protectin D&#59; COX-2&#58; cyclooxygenase-2&#59; DHA&#58; docosahexaenoic acid&#59; EPA&#58; eicosapentaenoic acid&#59; RvE1&#58; resolvin E1&#59; RvE2&#58; resolvin E2&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 2415
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            "Tamanyo" => 447467
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Major protective effects of low-dose aspirin&#46; AA&#58; arachidonic acid&#59; ATL&#58; aspirin-triggered lipoxin&#59; COX-1&#58; cyclooxygenase-1&#59; COX-2&#58; cyclooxygenase-2&#59; eNOS&#58; endothelial nitric oxide synthase&#59; NO&#58; nitric oxide&#59; PD&#58; protectin&#59; Rvs&#58; resolvins&#59; TXA<span class="elsevierStyleInf">2</span>&#58; thromboxane A<span class="elsevierStyleInf">2</span>&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "fig0020"
        "etiqueta" => "Figure 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr4.jpeg"
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Major protective effects of medium&#47;high-dose aspirin&#46; COX-2&#58; cyclooxygenase-2&#59; NF-&#954;B&#58; nuclear factor kappa B&#59; PGE2&#58; prostaglandin E<span class="elsevierStyleInf">2</span>&#59; PYK2&#58; proline-rich tyrosine kinase 2&#59; TXA<span class="elsevierStyleInf">2</span>&#58; thromboxane A<span class="elsevierStyleInf">2</span>&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">&#8593;&#58; increase&#91;d&#93;&#59; &#8595;&#58; decrease&#91;d&#93;&#59; AA&#58; arachidonic acid&#59; BP&#58; blood pressure&#59; COX-2&#58; cyclooxygenase-2&#59; PG&#58; prostaglandins&#59; SHR&#58; spontaneously hypertensive rats&#59; WKY&#58; Wistar-Kyoto rats&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total no&#46; of rats&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No&#46; of rats taking aspirin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Aspirin dose&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Duration of aspirin treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Antihypertensive treatment&#47;dose&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Effect of combined aspirin treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Other effects&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">DiNicolantonio et al&#46;<a class="elsevierStyleCrossRef" href="#bib0760"><span class="elsevierStyleSup">65</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32 male SHR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 &#40;8 with aspirin&#59; 8 with aspirin&#43;captopril&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11-15 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">200 mg&#47;kg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Captopril<br>30 mg&#47;kg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No significant change in antihypertensive effect&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8595; production of vasodilator prostanoids from exogenous AA with aspirin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tuttle et al&#46;<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">11</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31 male SHR<br>31 male WKY&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25 SHR<br>25 WKY&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">75-100 mg&#47;kg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">56 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Metoprolol<br>0&#46;75-1&#46;0 mg&#47;kg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Loss of the antihypertensive effect in SHR but not in WKY&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Metoprolol or aspirin alone prevented BP rise in WKY and SHR<br>&#8593; renal PG content &#40;PGF<span class="elsevierStyleInf">1&#945;</span>&#43;PGF<span class="elsevierStyleInf">2&#945;</span>&#41; in older SHR &#40;vs&#46; age-matched WKY&#41;<br>&#8595; renal PG content was found in SHR receiving aspirin&#44; metoprolol or both&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Quilley et al&#46;<a class="elsevierStyleCrossRef" href="#bib0765"><span class="elsevierStyleSup">66</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">40 male SHR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8-10 rats with aspirin&#59; 8-10 rats with aspirin&#43;captopril&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20-40 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">200 mg&#47;kg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Captopril<br>30 mg&#47;kg twice&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aspirin &#8593; the antihypertensive effect of captopril&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aspirin &#8593; urine flow in SHR treated with captopril&#43;aspirin &#40;vs&#46; captopril alone&#41;<br>&#8595; in renal PG excretion only in the first 4 hours of aspirin administration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dubey et al&#46;<a class="elsevierStyleCrossRef" href="#bib0770"><span class="elsevierStyleSup">67</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24 male Wistar normotensive rats<br>32 male Wistar hypertensive rats induced by methylprednisolone<br>&#40;20 mg&#47;kg per week&#44; for 2 weeks&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Adults&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25 mg&#47;kg&#47;day<br>100 mg&#47;kg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Lisinopril<br>15 mg&#47;kg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No significant change in the antihypertensive effect of lisinopril&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Absence of structural abnormalities in cardiac and renal tissues of normotensive rats treated with lisinopril&#43;aspirin or lisinopril alone<br>Degenerative changes in hypertensive rats treated with aspirin&#43;lisinopril &#40;observed even with lower aspirin dose&#41;<br>Significant &#8593; in mortality in hypertensive rats treated with lisinopril&#43;high-dose aspirin &#40;vs&#46; lisinopril alone&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sousa et al&#46;<a class="elsevierStyleCrossRefs" href="#bib0745"><span class="elsevierStyleSup">62&#44;64</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32 male SHR<br>32 male WKY&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 SHR &#40;8 with aspirin&#59; 8 with aspirin&#43;losartan&#41;<br>16 WKY &#40;8 with aspirin&#59; 8 with aspirin&#43;losartan&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 mg&#47;kg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Losartan<br>15 mg&#47;kg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No significant change in the antihypertensive effect of losartan in WKY rats<br>In SHR&#44; &#8593; in antihypertensive effect of losartan with aspirin<br>&#40;SBP&#58;SHR&#43;aspirin&#43;losartan&#58; 174&#46;5&#177;0&#46;9 mmHg&#59; SHR&#43;losartan&#58; 186&#46;3&#177;1&#46;4 mmHg&#44; p&#60;0&#46;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Significant &#8595; of renal COX-2 expression and vasoconstrictive eicosanoids in SHR&#43;aspirin&#43;losartan &#40;vs&#46; SHR&#43;losartan&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">&#8593;&#58; increase&#91;d&#93;&#59; &#8595;&#58; decrease&#91;d&#93;&#59; ABPM&#58; ambulatory blood pressure measurement&#59; ACEIs&#58; angiotensin-converting enzyme inhibitors&#59; ARBs&#58; angiotensin receptor blockers&#59; BBs&#58; beta-blockers&#59; BP&#58; blood pressure&#59; CV&#58; cardiovascular&#59; DBP&#58; diastolic blood pressure&#59; HOT&#58; Hypertension Optimal Treatment&#59; LIFE&#58; Losartan Intervention For Endpoint reduction in hypertension&#59; MAP&#58; mean arterial pressure&#59; PGI<span class="elsevierStyleInf">2</span>&#58; prostacyclin&#59; PRA&#58; plasma renin activity&#59; PPP&#58; Primary Prevention Project&#59; SBP&#58; systolic blood pressure&#59; SD&#58; standard deviation&#59; SEM&#58; standard error of the mean&#59; TXB<span class="elsevierStyleInf">2</span>&#58; thromboxane B<span class="elsevierStyleInf">2</span>&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Study design&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No&#46; of patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No&#46; of patients taking aspirin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Age &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Aspirin dose&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Duration of aspirin treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Antihypertensive treatment&#47;dose&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Effect of combined aspirin treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Other effects&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Smith et al&#46;<a class="elsevierStyleCrossRef" href="#bib0840"><span class="elsevierStyleSup">81</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Double-blind&#44; randomized&#44; crossover study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">53&#46;3&#177;10&#46;6 &#40;mean &#177; SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">75 mg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Captopril 25 mg every 12 hours&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No significant change in MAP &#40;office BP&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Treatment with captopril&#43;aspirin &#8595; serum &#40;but not urinary&#41; TXB<span class="elsevierStyleInf">2</span><br>No significant linear correlation of serum TXB<span class="elsevierStyleInf">2</span> with MAP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Magagna et al&#46;<a class="elsevierStyleCrossRef" href="#bib0810"><span class="elsevierStyleSup">75</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Randomized&#44; placebo controlled&#44; double-blind&#44; two-period crossover trial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30<br>&#40;20 treated hypertensive patients&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">45&#46;7&#177;4&#46;5 &#40;total&#44; mean &#177; SEM&#41;<br>41&#46;5&#177;3&#46;9 &#40;atenolol group&#41;<br>47&#46;8&#177;5&#46;0 &#40;captopril group&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100 mg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Atenolol 100 mg&#47;day<br>Captopril 50 mg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No significant change in office BP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aspirin significantly &#8595; serum and urinary TXB<span class="elsevierStyleInf">2</span> in captopril- and atenolol-treated patients &#40;vs&#46; baseline and placebo&#41;<br>Aspirin significantly &#8595; PRA in captopril- but not in atenolol-treated patients<br>Aspirin slightly &#40;though not significantly&#41; &#8595; urinary 6-keto-PGF1&#945; &#40;PGI<span class="elsevierStyleInf">2</span> metabolite&#41; values in both captopril and atenolol groups&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pol&#243;nia et al&#46;<a class="elsevierStyleCrossRef" href="#bib0845"><span class="elsevierStyleSup">82</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Randomized crossover study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">52&#46;6&#177;1&#46;9 &#40;mean &#177; SEM&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100 mg&#47;day<br>Taken in the morning&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nifedipine &#40;30 mg&#41; or enalapril &#40;20 mg&#41;&#47;day for 4 weeks &#40;in responders to antihypertensive therapy&#41;<br>Nifedipine &#40;60 mg&#41; or enalapril &#40;40 mg&#41; for 4 weeks &#40;in non-responders at the 4th week of the 1st treatment period&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No effect on office BP in nifedipine- or enalapril-treated patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Guazzi et al&#46;<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">10</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Randomized&#44; placebo-controlled&#44; crossover study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">52<br>&#40;26 with mild hypertension&#44; 26 with severe hypertension&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">54&#177;8<br>&#40;mean &#177; SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100 mg&#47;day<br>or<br>300 mg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Enalapril 20 mg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aspirin 100 mg had no effect on office BP&#44; either alone or in combination with enalapril<br>Aspirin 300 mg &#8595; the efficacy of enalapril by 63&#37; in mild hypertensives and by 91&#37; in severe hypertensives&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">In aspirin 300 mg responders &#40;i&#46;e&#46; with more than 20&#37; attenuation of enalapril&#39;s antihypertensive effect&#41;&#44; the enalapril-induced rise in PRA was significantly inhibited&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hansson et al&#46;<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">4</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospective&#44; randomized&#44; open with blinded endpoint evaluation &#40;PROBE&#41; design<br>&#40;HOT randomized trial&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18<span class="elsevierStyleHsp" style=""></span>790<br>&#40;491 lost to follow-up&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9399<br>&#40;245 lost to follow-up in aspirin group&#41;<br>&#40;246 of 9391 patients assigned to placebo group lost to follow-up&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">61&#46;5 &#40;mean&#41; for those remaining in the study<br>61&#46;3 &#40;mean&#41; for those lost to follow-up&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">75 mg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;8 years &#40;mean&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Step 1&#58; Felodipine 5 mg&#47;day given to all patients<br>&#40;additional therapy and dose increments in further steps to reach the randomized target BP&#41;<br>Step 2&#58; ACEI or BB added<br>Step 3&#58; felodipine 10 mg once a day<br>Step 4&#58; doubling the dose of either the ACEI or the BB<br>Step 5&#58; diuretic added&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No differences in achieved BP &#40;office BP&#41; in patients randomized to aspirin or placebo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Association of aspirin with antihypertensive treatment &#8595; the risk of acute myocardial infarction without raising the risk of cerebral bleeding&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nawarskas et al&#46;<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">14</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Double-blind&#44; placebo-controlled&#44; partial crossover&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">44&#177;8&#46;9<br>&#40;enalapril group&#44; n&#61;7&#44; mean &#177; SD&#41;<br>47&#177;13&#46;2 &#40;losartan group&#44; n&#61;10&#44; mean &#177; SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">81 mg&#47;day<br>or<br>325 mg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Enalapril &#8805;5 mg&#47;day<br>Losartan &#8805;25 mg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No significant change in MAP&#44; SBP or DBP &#40;office BP&#41; for both aspirin doses in both enalapril and losartan groups&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8595; serum TXB<span class="elsevierStyleInf">2</span> in both enalapril and losartan groups treated with aspirin<br>Complete suppression of TXB<span class="elsevierStyleInf">2</span> in response to aspirin 325 mg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Avanzini et al&#46;<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">13</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Randomized&#44; controlled&#44; open&#44; 2&#215;2 factorial trial<br>&#40;conducted in the framework of the PPP&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">142&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">59&#46;0&#177;6&#46;0 &#40;total&#44; mean &#177; SD&#41;<br>58&#46;9&#177;6&#46;4 &#40;aspirin&#41;<br>59&#46;2&#177;5&#46;6 &#40;control&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100 mg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ACEIs &#40;51&#46;1&#37; of patients&#41;<br>Calcium antagonists &#40;48&#46;2&#37;&#41;<br>BBs &#40;29&#46;8&#37;&#41;<br>Diuretics &#40;18&#46;4&#37;&#41;<br>Alpha-blockers &#40;14&#46;2&#37;&#41;<br>ARBs &#40;6&#46;4&#37;&#41;<br>Centrally acting agents &#40;3&#46;5&#37;&#41;<br>Drugs and dose not specified&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No change in office BP or in 24-hour BP &#40;on ABPM&#41; compared to baseline<br>Similar BP pattern in control group&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fisman et al&#46;<a class="elsevierStyleCrossRef" href="#bib0850"><span class="elsevierStyleSup">83</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Self-matched control study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31 non-smoking hypertensive or post-infarction patients with ACEI- induced cough&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">61&#177;0&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100 mg&#47;day followed by 500 mg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 week<br>&#40;100 mg&#47;day&#41;<br>&#43;1 week<br>&#40;500 mg&#47;day&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ACEIs<br>Drug and dose not specified&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aspirin did not influence BP control in hypertensives or in post-infarction patients&#44; regardless of dose&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aspirin 100 mg had no effect on ACEI-induced cough<br>Aspirin 500 mg markedly &#8595; ACEI-induced cough in the majority of patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Zanchetti et al&#46;<a class="elsevierStyleCrossRef" href="#bib0860"><span class="elsevierStyleSup">85</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Post-hoc subgroup analysis of HOT trial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18&#160;790<br>&#40;491 lost to follow-up&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9399<br>&#40;245 lost to follow-up in aspirin group&#41;<br>&#40;246 of 9391 patients assigned to placebo group lost to follow-up&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">61&#46;5 &#40;mean&#41; for those remaining in the study<br>61&#46;3 &#40;mean&#41; for those lost to follow-up&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">75 mg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;8 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Step 1&#58; Felodipine 5 mg&#47;day given to all patients<br>&#40;additional therapy and dose increments in further steps to reach the randomized target BP&#41;<br>Step 2&#58; ACEI or BB added<br>Step 3&#58; felodipine 10 mg once a day<br>Step 4&#58; doubling the dose of either the ACEI or the BB<br>Step 5&#58; diuretic added&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">The SBP and DBP &#40;office BP&#41; values achieved&#44; the intensity of the antihypertensive regimen&#44; and the number and type of drug used were similar in aspirin and placebo patients&#44; not only in the overall HOT Study population&#44; but in all subgroups&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fossum et al&#46;<a class="elsevierStyleCrossRef" href="#bib0510"><span class="elsevierStyleSup">15</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Subgroup post-hoc analysis of LIFE study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9193&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1970 with aspirin at baseline &#40;1004 in the losartan group&#59; 966 in the atenolol group&#41; &#40;7223 without aspirin&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">68&#46;4&#177;6&#46;7 &#40;mean &#177; SD&#44; aspirin at baseline&#41;<br>66&#46;6&#177;7&#46;0 &#40;mean &#177; SD&#44; without aspirin at baseline&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aspirin dose not specified &#40;probably low-dose used for prevention of CV events&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;7 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Losartan 50 mg or 100 mg with or without additional antihypertensive drugs<br>Atenolol 50 mg or 100 mg with or without additional drugs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Office BP was similarly &#8595; in aspirin&#43;losartan or aspirin&#43;atenolol patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Greater &#8595; in CV death&#44; stroke&#44; and myocardial infarction with losartan-based compared to atenolol-based treatment in patients using aspirin &#40;vs&#46; patients not using aspirin at baseline&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Prikryl et al&#46;<a class="elsevierStyleCrossRef" href="#bib0855"><span class="elsevierStyleSup">84</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Crossover&#44; double-blind&#44; randomized trial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">46&#46;7&#177;8&#46;6 &#40;mean &#177; SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100 mg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 days&#44; each day at a different circadian stage &#40;on awakening&#44; i&#46;e&#46;&#44; 06&#58;00&#44; and 3&#44; 6&#44; 9&#44; 12&#44; 15&#44; and 18 hours after awakening&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Telmisartan 80 mg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Addition of aspirin to telmisartan further &#8595; circadian amplitude of SBP and DBP &#40;office BP&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Addition of aspirin to telmisartan further &#8595; heart rate amplitude and intrarenal resistive index&#59; it also caused a slight &#8593; in ejection fraction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Leinonen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0545"><span class="elsevierStyleSup">22</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Observational&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">905&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">246&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">65&#46;5&#177;10&#46;9 &#40;total&#44; mean &#177; SD&#41;<br>69&#46;4&#177;9&#46;4 &#40;aspirin group&#41;<br>64&#46;1&#177;11&#46;1 &#40;no aspirin group&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50-250 mg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aspirin given either on the day of measurement or at least 3 times during the preceding week&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Antihypertensive monotherapy &#40;41&#37; aspirin vs&#46; 47&#46;5&#37; no aspirin&#41;&#58;<br>- ACEIs &#40;9&#46;8&#37; vs&#46; 14&#46;6&#37;&#41;<br>- ARBs &#40;1&#46;6&#37; vs&#46; 4&#46;2&#37;&#41;<br>- BBs &#40;15&#46;4&#37; vs&#46; 12&#46;0&#37;&#41;<br>- Calcium antagonists &#40;8&#46;1&#37; vs&#46; 9&#46;1&#37;&#41;<br>- Central acting drugs &#40;0&#37; vs&#46; 0&#46;3&#37;&#41;<br>- Diuretics &#40;6&#46;1&#37; vs&#46; 7&#46;3&#37;&#41;<br>- Combination therapy &#40;58&#46;9&#37; vs&#46; 52&#46;6&#37;&#41;<br>Drugs and dose not specified&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aspirin-treated patients had &#8595; DBP and MAP &#40;office BP&#41;<br>Aspirin &#8595; DBP regardless of whether patients were on antihypertensive monotherapy or combination therapy<br>In univariate linear regression&#44; the use of aspirin was associated with &#8595; DBP and MAP<br>In stepwise multiple linear regression&#44; the use of aspirin remained a significant independent predictor of &#8595; DBP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dimitrov et al&#46;<a class="elsevierStyleCrossRef" href="#bib0865"><span class="elsevierStyleSup">86</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Randomized&#44; open-label&#44; crossover trial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">75 with long-standing hypertension<br>&#40;12&#177;10 years of hypertension&#44; mean &#177; SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">65&#177;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">75 mg&#47;day &#40;64&#37; of patients&#41;<br>80-160 mg&#47;day<br>&#40;33&#37; of patients&#41;<br>300 mg&#47;day<br>&#40;3&#37; of patients&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">One group &#40;n&#61;39&#41; taking aspirin for 1 month in the evening&#44; followed by 1 month in the morning<br>Another group &#40;n&#61;36&#41; taking aspirin for 1 month in the morning&#44; then 1 month in the evening&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">One antihypertensive drug - 13 patients<br>Two drugs - 17<br>patients<br>Three drugs - 26 patients<br>Four drugs - 12 patients<br>Five drugs - 6 patients<br>Six drugs - 1 patient<br>Drugs and doses not specified&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">The time of aspirin administration did not significantly modify 24-hour SBP or 24-hour DBP&#44; or diurnal or nocturnal SBP and DBP &#40;ABPM&#41; values&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bonten et al&#46;<a class="elsevierStyleCrossRef" href="#bib0870"><span class="elsevierStyleSup">87</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospective&#44; randomized&#44; open-label&#44; blinded endpoint &#40;PROBE&#41;&#44; 2-period crossover study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">290 with CV disease &#40;263 in the final analysis&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">290 &#40;263 in the final analysis&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">64&#177;7<br>&#40;mean &#177; SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100 mg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">One group &#40;n&#61;134&#41; taking aspirin on awakening for 3 months&#44; followed by aspirin at bedtime for the same period<br>Another group &#40;n&#61;129&#41; taking aspirin at bedtime for 3 months&#44; followed by aspirin on awakening for the same period&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">BBs &#40;51&#37; in the awakening-bedtime group vs&#46; 55&#37; in the bedtime-awakening group&#41;<br>ACEIs &#40;41&#37; vs&#46; 38&#37;&#41;<br>ARBs &#40;26&#37; vs&#46; 23&#37;&#41;<br>Calcium antagonists &#40;20&#37; vs&#46; 19&#37;&#41;<br>Diuretics &#40;26&#37; vs&#46; 32&#37;&#41;<br>Drugs and doses not specified&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aspirin intake at bedtime did not &#8595; BP compared with intake on awakening&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bedtime aspirin significantly &#8595; morning platelet reactivity compared to aspirin on awakening&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Interaction of aspirin with antihypertensive drugs in hypertensive patients&#46;</p>"
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                      "titulo" => "2013 ESH&#47;ESC Guidelines for the management of arterial hypertension&#58; the Task Force for the management of arterial hypertension of the European Society of Hypertension &#40;ESH&#41; and of the European Society of Cardiology &#40;ESC&#41;"
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Review Article
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
Ana Catarina Costaa, Marta Reina-Coutoa,b,c, António Albino-Teixeiraa,b,
Autor para correspondência
albinote@med.up.pt

Corresponding author.
, Teresa Sousaa,b,
Autor para correspondência
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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            "entidad" => "Departamento de Medicina Intensiva&#44; Centro Hospitalar S&#227;o Jo&#227;o&#44; Porto&#44; Portugal"
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        "titulo" => "Aspirina e press&#227;o arterial&#58; efeitos do uso isolado ou em associa&#231;&#227;o com f&#225;rmacos anti-hipertensores"
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          "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Biosynthesis of aspirin-triggered resolvins and protectin&#46; 5-LOX&#58; 5-lipoxygenase&#59; 17R-HDHA&#58; 17R-hydroxydocosahexaenoic acid&#59; 18R-HETE&#58; 18R-hydroxyeicosapentaenoic acid&#59; AT-RvD1&#58; aspirin-triggered resolvin D1&#59; AT-RvD2&#58; aspirin-triggered resolvin D2&#59; AT-RvD3&#58; aspirin-triggered resolvin D3&#59; AT-RvD4&#58; aspirin-triggered resolvin D4&#59; AT-PD&#58; aspirin-triggered protectin D&#59; COX-2&#58; cyclooxygenase-2&#59; DHA&#58; docosahexaenoic acid&#59; EPA&#58; eicosapentaenoic acid&#59; RvE1&#58; resolvin E1&#59; RvE2&#58; resolvin E2&#46;</p>"
        ]
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Introduction</span><p id="par0235" class="elsevierStylePara elsevierViewall">Arterial hypertension affects 30-45&#37; of the general population in Europe&#46;<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">1</span></a> In Portugal&#44; its prevalence was found to be 42&#46;2&#37;&#44; with a rate of blood pressure &#40;BP&#41; control of only 55&#46;7&#37; among treated patients&#46;<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">2</span></a> Hypertension is a major risk factor for cardiovascular and renal events<a class="elsevierStyleCrossRefs" href="#bib0440"><span class="elsevierStyleSup">1&#44;3</span></a> and lowering BP is an important strategy for reducing morbidity and mortality&#46;<a class="elsevierStyleCrossRefs" href="#bib0450"><span class="elsevierStyleSup">3&#44;4</span></a></p><p id="par0240" class="elsevierStylePara elsevierViewall">Associating antihypertensive medication with correction of other cardiovascular risk factors is also an important way to increase treatment benefits in hypertensive patients&#46; Low-dose aspirin plays an essential role in the prevention of adverse cardiovascular outcomes&#44; especially in patients with previous cardiovascular events&#46;<a class="elsevierStyleCrossRefs" href="#bib0440"><span class="elsevierStyleSup">1&#44;5&#8211;7</span></a> Although it is commonly combined with antihypertensive medication&#44; aspirin therapy is controversial in individuals without a history of cardiovascular disease&#46; According to the 2013 European guidelines for the management of hypertension&#44; low-dose aspirin should be prescribed for controlled hypertensive patients with previous cardiovascular events and considered for hypertensive patients with renal dysfunction or high cardiovascular risk&#44; but is not recommended for low-to-moderate risk hypertensive patients in whom absolute benefit and harm are equivalent&#46;<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">1</span></a> Similar recommendations on aspirin use have been reported in the recent European guidelines for cardiovascular disease prevention&#46;<a class="elsevierStyleCrossRef" href="#bib0475"><span class="elsevierStyleSup">8</span></a></p><p id="par0245" class="elsevierStylePara elsevierViewall">The impact on BP of the combination of aspirin with first-line antihypertensive drugs&#44; such as beta-blockers &#40;BBs&#41;&#44; angiotensin converting enzyme inhibitors &#40;ACEIs&#41; and angiotensin receptor blockers &#40;ARBs&#41;&#44; has also been the subject of intense debate&#46; There are reports of negative interactions with BBs or ACEIs&#44;<a class="elsevierStyleCrossRefs" href="#bib0480"><span class="elsevierStyleSup">9&#8211;12</span></a> while other studies have shown no influence on the BP-lowering effect of ACEIs and ARBs&#46;<a class="elsevierStyleCrossRefs" href="#bib0500"><span class="elsevierStyleSup">13&#8211;15</span></a> Discussion of the benefits and harms of aspirin therapy in patients taking antihypertensive drugs extends to its effects on other cardiovascular parameters or endpoints&#46;<a class="elsevierStyleCrossRefs" href="#bib0510"><span class="elsevierStyleSup">15&#8211;17</span></a></p><p id="par0250" class="elsevierStylePara elsevierViewall">The present review aims to provide an overview of the effects of aspirin on blood pressure and the underlying mechanisms&#44; focusing on the interaction between aspirin and antihypertensive drugs&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Aspirin and inhibition of cyclooxygenase-1 and cyclooxygenase-2</span><p id="par0255" class="elsevierStylePara elsevierViewall">Aspirin&#39;s pharmacological effects have been attributed to the inhibition of cyclooxygenase &#40;COX&#41; enzymatic activity and further arachidonic acid &#40;AA&#41; metabolism&#46;<a class="elsevierStyleCrossRef" href="#bib0525"><span class="elsevierStyleSup">18</span></a> COX-1 is a constitutively expressed enzyme isoform responsible for the synthesis of prostanoids from AA&#46; These include thromboxane A<span class="elsevierStyleInf">2</span> &#40;TXA<span class="elsevierStyleInf">2</span>&#41; and prostaglandins &#40;PGs&#41;&#44; which mediate various homeostatic functions such as gastric protection&#44; renal blood flow regulation and platelet aggregation&#46; In contrast&#44; the COX-2 isoform is mostly expressed in response to inflammatory stimuli&#44; mitogens and growth factors&#44; and generates PGs involved in pain signaling&#44; fever and tissue repair&#44; although it is also constitutively expressed in the macula densa and renal medulla&#44; contributing to the regulation of kidney function&#46;<a class="elsevierStyleCrossRefs" href="#bib0525"><span class="elsevierStyleSup">18&#8211;21</span></a></p><p id="par0260" class="elsevierStylePara elsevierViewall">The irreversible acetylation of COX-1 by low-dose aspirin reduces TXA<span class="elsevierStyleInf">2</span> biosynthesis in platelets&#44; which inhibits platelet aggregation&#44; thus contributing to cardioprotection&#46;<a class="elsevierStyleCrossRefs" href="#bib0525"><span class="elsevierStyleSup">18&#44;22</span></a> In addition&#44; the decrease in TXA<span class="elsevierStyleInf">2</span> levels may also account for the attenuation of vasoconstriction&#46;<a class="elsevierStyleCrossRefs" href="#bib0525"><span class="elsevierStyleSup">18&#44;23</span></a> Higher aspirin doses are required to block COX-2 activity and achieve analgesic&#44; antipyretic and anti-inflammatory effects&#46; COX-2 blockade decreases the synthesis of prostacyclin &#40;PGI<span class="elsevierStyleInf">2</span>&#41;&#44; a potent vasodilator and inhibitor of platelet aggregation&#44; and of other PGs such as prostaglandin E<span class="elsevierStyleInf">2</span> &#40;PGE<span class="elsevierStyleInf">2</span>&#41; that are involved in the control of BP and renal function&#46;<a class="elsevierStyleCrossRefs" href="#bib0525"><span class="elsevierStyleSup">18&#44;21&#44;22&#44;24</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Aspirin and production of pro-resolving lipid mediators</span><p id="par0265" class="elsevierStylePara elsevierViewall">In recent years&#44; a new paradigm of the inflammatory process has emerged&#44; with the discovery of specialized pro-resolving lipid mediators &#40;SPMs&#41; such as lipoxins &#40;LXs&#41;&#44; resolvins &#40;Rvs&#41; and protectins &#40;PDs&#41;&#44; that actively stimulate the resolution of inflammation and tissue regeneration&#46;<a class="elsevierStyleCrossRef" href="#bib0560"><span class="elsevierStyleSup">25</span></a> SPMs are biosynthesized in transcellular processes involving AA or omega-3 fatty acids as precursors and the cooperation of several lipoxygenases &#40;LOXs&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0565"><span class="elsevierStyleSup">26</span></a></p><p id="par0270" class="elsevierStylePara elsevierViewall">Interestingly&#44; the acetylation of COX-2 by aspirin triggers the production of SPMs&#46; In contrast to what occurs with COX-1&#44; which becomes irreversibly inhibited&#44; COX-2 acetylation by aspirin only changes its activity profile&#44; yielding 15&#40;R&#41;-hydroxyeicosatetraenoic acid &#40;15R-HETE&#41; from AA&#44; instead of the PG precursor PGH<span class="elsevierStyleInf">2</span>&#46; 15R-HETE is further metabolized into 15R-epimeric LXA<span class="elsevierStyleInf">4</span> &#40;15-epi-LXA<span class="elsevierStyleInf">4</span>&#41; or 15R-epimeric LXB<span class="elsevierStyleInf">4</span> &#40;15-epi-LXB<span class="elsevierStyleInf">4</span>&#41;&#44; which are also known as aspirin-triggered LXs &#40;ATL&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0565"><span class="elsevierStyleSup">26&#8211;28</span></a> Of note&#44; this effect appears to be aspirin-specific&#44; since it is not shared by other nonsteroidal anti-inflammatory drugs &#40;NSAIDs&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0570"><span class="elsevierStyleSup">27&#44;29</span></a> LXs and ATL exert several anti-inflammatory and pro-resolving effects&#44; including inhibition of neutrophil recruitment&#44; stimulation of neutrophil apoptosis and removal by macrophages&#44; inhibition of proinflammatory cytokine synthesis&#44; and stimulation of anti-inflammatory cytokine production&#46;<a class="elsevierStyleCrossRef" href="#bib0565"><span class="elsevierStyleSup">26</span></a> LXs and ATL also inhibit generation of reactive oxygen species &#40;ROS&#41;&#44; induce expression of antioxidant molecules and stimulate nitric oxide &#40;NO&#41; and PGI<span class="elsevierStyleInf">2</span> production and endothelium-dependent vasodilation&#46;<a class="elsevierStyleCrossRefs" href="#bib0565"><span class="elsevierStyleSup">26&#44;30</span></a> ATL biosynthesis has been demonstrated in healthy subjects treated with low-dose aspirin for eight weeks&#46; Since ATL was generated in sufficient levels to achieve anti-inflammatory and pro-resolving effects&#44; it is conceivable that it contributes to the cardiovascular benefits of aspirin&#46;<a class="elsevierStyleCrossRef" href="#bib0580"><span class="elsevierStyleSup">29</span></a> Our group also reported that patients with mild-to-moderate chronic heart failure treated with low-dose aspirin had a four-fold higher urinary excretion of ATL compared to untreated patients&#46;<a class="elsevierStyleCrossRef" href="#bib0590"><span class="elsevierStyleSup">31</span></a> Of note&#44; it has recently been shown that LXs and ATL promote reverse cholesterol transport&#44; thus suggesting that these SPMs may be promising therapeutic allies in cardiovascular disease prevention&#46;<a class="elsevierStyleCrossRefs" href="#bib0595"><span class="elsevierStyleSup">32&#44;33</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0275" class="elsevierStylePara elsevierViewall">Aspirin-acetylated COX-2 also triggers the production of other SPMs from omega-3 fatty acids&#46; Aspirin-triggered D-series Rvs and aspirin-triggered PDs are generated from docosahexaenoic acid&#44; while E-series Rvs are produced from eicosapentaenoic acid &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#41;&#46; These SPMs also exert anti-inflammatory and pro-resolving effects&#44; as well as protective effects on redox status and vascular reactivity&#46;<a class="elsevierStyleCrossRef" href="#bib0565"><span class="elsevierStyleSup">26</span></a></p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Aspirin and redox status</span><p id="par0280" class="elsevierStylePara elsevierViewall">Oxidative stress contributes to the pathogenesis of hypertension&#46;<a class="elsevierStyleCrossRefs" href="#bib0605"><span class="elsevierStyleSup">34&#8211;39</span></a> Given the interplay between inflammation and oxidative stress&#44;<a class="elsevierStyleCrossRef" href="#bib0635"><span class="elsevierStyleSup">40</span></a> it has been suggested that aspirin might have antioxidant properties that account for its cardiovascular benefits&#46; Wu et al&#46; observed that treatment with aspirin for 12 days significantly dose-dependently &#40;10-100 mg&#47;kg&#47;day&#41; reduced vascular superoxide &#40;O<span class="elsevierStyleInf">2</span><span class="elsevierStyleGlyphrad"></span><span class="elsevierStyleSup">&#8722;</span>&#41; production by lowering nicotinamide adenine dinucleotide phosphate &#40;NADPH&#41; oxidase activity in normotensive Wistar-Kyoto rats &#40;WKY&#41; and spontaneously hypertensive rats &#40;SHR&#41;&#46; Aspirin also restored acetylcholine-induced vasorelaxation in aortic rings from SHR&#44; but not from WKY&#46; In Sprague Dawley &#40;SD&#41; rats&#44; aspirin also inhibited angiotensin II &#40;Ang II&#41;-induced O<span class="elsevierStyleInf">2</span><span class="elsevierStyleGlyphrad"></span><span class="elsevierStyleSup">&#8722;</span> generation and attenuated the progression of hypertension&#46; Furthermore&#44; long-term treatment initiated in normotensive young SHR attenuated the development of hypertension&#44; but did not alter BP in young WKY or in adult SHR&#46;<a class="elsevierStyleCrossRef" href="#bib0640"><span class="elsevierStyleSup">41</span></a> Wu et al&#46; further demonstrated that treatment of SD rats with aspirin &#40;100 mg&#47;kg&#47;day for 12 days&#41; prevented Ang II-induced production of O<span class="elsevierStyleInf">2</span><span class="elsevierStyleGlyphrad"></span><span class="elsevierStyleSup">&#8722;</span> in cardiovascular tissues&#44; as well as O<span class="elsevierStyleInf">2</span><span class="elsevierStyleGlyphrad"></span><span class="elsevierStyleSup">&#8722;</span> and protein synthesis in cultured smooth muscle cells &#40;SMC&#41;&#46; It also prevented Ang II-induced hypertension and cardiac hypertrophy&#46; In contrast&#44; other NSAIDs failed to prevent Ang II-induced effects in vivo&#46;<a class="elsevierStyleCrossRef" href="#bib0645"><span class="elsevierStyleSup">42</span></a></p><p id="par0285" class="elsevierStylePara elsevierViewall">In cultured mice cardiac fibroblasts&#44; pretreatment with aspirin or salicylic acid in therapeutically relevant concentrations suppressed Ang II-induced NADPH oxidase expression&#44; ROS generation and activation of the transcription factor nuclear factor-kappa B &#40;NF-&#954;B&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0650"><span class="elsevierStyleSup">43</span></a></p><p id="par0290" class="elsevierStylePara elsevierViewall">Of note&#44; ATL also exerts protective effects on redox status&#46; In endothelial cells&#44; treatment with ATL blocked NADPH oxidase-mediated ROS production and increased the expression of the antioxidant molecule heme-oxygenase-1&#46;<a class="elsevierStyleCrossRefs" href="#bib0655"><span class="elsevierStyleSup">44&#44;45</span></a> ATL also inhibited ROS generation in leukocytes&#46;<a class="elsevierStyleCrossRefs" href="#bib0665"><span class="elsevierStyleSup">46&#44;47</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Aspirin and vascular tone</span><p id="par0295" class="elsevierStylePara elsevierViewall">Vascular tone is a determinant of peripheral resistance and consequently of BP&#46; Aspirin and salicylates may lower BP through a COX-independent mechanism involving the inhibition of a non-receptor tyrosine kinase&#44; proline-rich tyrosine kinase 2 &#40;PYK2&#41;&#44; in vascular SMCs&#46;<a class="elsevierStyleCrossRefs" href="#bib0675"><span class="elsevierStyleSup">48&#44;49</span></a> PYK2 is activated by various physiological stimuli including Ang II&#44; and seems to be essential for RhoA&#47;Rho kinase activation&#44; which is critical for calcium sensitization of vascular smooth muscle and appears to be increased in hypertension&#46;<a class="elsevierStyleCrossRefs" href="#bib0675"><span class="elsevierStyleSup">48&#44;50</span></a> Both aspirin and sodium salicylate relaxed preconstricted vessels by inhibiting PYK2-mediated RhoA&#47;Rho-kinase activation&#46; This occurred at higher concentrations than those necessary to inhibit COX&#46;<a class="elsevierStyleCrossRef" href="#bib0675"><span class="elsevierStyleSup">48</span></a></p><p id="par0300" class="elsevierStylePara elsevierViewall">Exploratory clinical trials have also suggested that low-dose aspirin improves endothelium-dependent vasodilation<a class="elsevierStyleCrossRefs" href="#bib0690"><span class="elsevierStyleSup">51&#8211;53</span></a> and it has therefore been hypothesized that aspirin might stimulate the release of NO from the vascular endothelium&#46;<a class="elsevierStyleCrossRef" href="#bib0705"><span class="elsevierStyleSup">54</span></a> Taubert et al&#46; demonstrated that low concentrations of aspirin elicited the release of NO from vascular endothelium and increased the activity of endothelial NO synthase &#40;eNOS&#41;&#46; This effect appears to be independent of COX but related to direct acetylation of eNOS&#44; and seems to be selective for aspirin since salicylate and indomethacin failed to modulate NO release&#46; Additionally&#44; higher aspirin concentrations scavenged O<span class="elsevierStyleInf">2</span><span class="elsevierStyleGlyphrad"></span><span class="elsevierStyleSup">&#8722;</span>&#44; thus preventing NO degradation&#46;<a class="elsevierStyleCrossRef" href="#bib0705"><span class="elsevierStyleSup">54</span></a></p><p id="par0305" class="elsevierStylePara elsevierViewall">The major protective effects of aspirin at low and medium&#47;high doses are summarized in <a class="elsevierStyleCrossRefs" href="#fig0015">Figures 3 and 4</a>&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Aspirin and blood pressure&#58; studies in experimental models of hypertension</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Effects when used alone</span><p id="par0310" class="elsevierStylePara elsevierViewall">The BP effects of aspirin were studied in two models of renovascular hypertension&#58; in one kidney&#44; one clip &#40;1K1C&#41;-hypertensive rats&#44; and in two kidney&#44; one clip &#40;2K1C&#41;-hypertensive rats&#46; Male SD rats were treated twice a day with aspirin 100 mg&#47;kg or vehicle and&#44; four days after beginning treatment&#44; their left renal artery was clipped &#40;2K1C rat model&#41;&#46; In another group&#44; besides left renal artery clipping&#44; the right kidney was also removed in all animals &#40;1K1C rat model&#41;&#46; BP was measured three weeks after surgery&#46; In comparison with vehicle-treated 2K1C rats&#44; aspirin-treated 2K1C rats exhibited higher BP values &#40;160 mmHg vs&#46; 140 mmHg&#44; p&#60;0&#46;05&#41;&#46; Interestingly&#44; aspirin treatment attenuated the BP increase in 1K1C rats &#40;153 mmHg vs&#46; 208 mmHg&#44; p&#60;0&#46;05&#41;&#46; Since 1K1C and 2K1C rats displayed different profiles in response to AA administration&#44; with 1K1C rats exhibiting an enhanced vasodepressor response to AA&#44; the authors suggested that aspirin decreases BP in hypertensive rats with increased activity of the COX pathway and raises BP in hypertensive rats that have a &#8216;normal&#8217; COX pathway&#46;<a class="elsevierStyleCrossRef" href="#bib0710"><span class="elsevierStyleSup">55</span></a></p><p id="par0315" class="elsevierStylePara elsevierViewall">Tuttle et al&#46; also assessed the antihypertensive effect of aspirin in SHR and WKY&#46; They first demonstrated that prolonged administration of aspirin &#40;100 mg&#47;kg&#47;daily&#41; to young SHR prevents the development of hypertension&#46;<a class="elsevierStyleCrossRef" href="#bib0715"><span class="elsevierStyleSup">56</span></a> Since aspirin loses its antihypertensive effect in adult SHR&#44; they investigated whether the loss of aspirin&#39;s effect on BP was associated with aging or with the duration of exposure to aspirin treatment&#46; A loss of aspirin&#39;s antihypertensive effect was found in all treated groups when SHR and WKY reached 110 days of age&#46; Furthermore&#44; since changes in PGF<span class="elsevierStyleInf">2</span>&#945;&#44; used as an index of COX activity&#44; did not parallel the BP alterations&#44; the authors assumed that the age of the animal&#44; and not a change in enzymatic activity or process over time&#44; was responsible for the loss of aspirin&#39;s antihypertensive effect&#46;<a class="elsevierStyleCrossRef" href="#bib0715"><span class="elsevierStyleSup">56</span></a> Similar results were obtained by Wu et al&#46;&#44; who observed significant attenuation of the development of hypertension in young SHR treated with aspirin &#40;100 mg&#47;kg&#47;day for 53 days&#41; but not in older aspirin-treated SHR or WKY&#46;<a class="elsevierStyleCrossRef" href="#bib0640"><span class="elsevierStyleSup">41</span></a> Nevertheless&#44; aspirin treatment significantly reduced aortic O<span class="elsevierStyleInf">2</span><span class="elsevierStyleGlyphrad"></span><span class="elsevierStyleSup">&#8722;</span> production in both old SHR and WKY&#46;<a class="elsevierStyleCrossRef" href="#bib0640"><span class="elsevierStyleSup">41</span></a></p><p id="par0320" class="elsevierStylePara elsevierViewall">The effect of aspirin on BP in SHR also appears to depend on baseline systolic BP &#40;SBP&#41; values&#46; In four-to-six-month old SHR&#44; a three-day treatment with aspirin &#40;100 mg&#47;kg&#47;day&#41; reduced SBP in the SHR group exhibiting SBP values above 161 mmHg before treatment&#46; In contrast&#44; in other SHR with baseline SBP below 160 mmHg&#44; aspirin significantly increased SBP&#44; and this elevation was more marked in SHR that had baseline normotensive SBP values&#46; Although the authors found no differences in the aortic production of TXA<span class="elsevierStyleInf">2</span> and PGI<span class="elsevierStyleInf">2</span>&#44; they speculated that the BP effects of aspirin were caused by inhibiting production of vasoconstrictor or vasodilator prostanoids&#46;<a class="elsevierStyleCrossRef" href="#bib0720"><span class="elsevierStyleSup">57</span></a></p><p id="par0325" class="elsevierStylePara elsevierViewall">In Ang II-infused rats&#44; concurrent aspirin treatment &#40;100 mg&#47;kg&#47;day for 12-14 days&#41; completely prevented Ang II-induced production of O<span class="elsevierStyleInf">2</span><span class="elsevierStyleGlyphrad"></span><span class="elsevierStyleSup">&#8722;</span> in cardiovascular tissues&#44; BP rise and cardiac hypertrophy&#46; These effects were not shared by other NSAIDs&#46;<a class="elsevierStyleCrossRef" href="#bib0645"><span class="elsevierStyleSup">42</span></a> When aspirin was given to Ang II-infused rats after the establishment of hypertension&#44; BP was significantly reduced after three days of treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0645"><span class="elsevierStyleSup">42</span></a> In chronically glucose-fed rats with elevated BP&#44; treatment with aspirin &#40;100 mg&#47;kg&#47;day for three weeks&#41; also prevented rises in SBP&#44; glucose levels and aortic O<span class="elsevierStyleInf">2</span><span class="elsevierStyleGlyphrad"></span><span class="elsevierStyleSup">&#8722;</span> production&#44; and attenuated insulin resistance&#46;<a class="elsevierStyleCrossRef" href="#bib0725"><span class="elsevierStyleSup">58</span></a></p><p id="par0330" class="elsevierStylePara elsevierViewall">The aspirin dose &#40;100 mg&#47;kg&#41; used in these studies is high&#44; being equivalent to a 1-g dose for a 70-kg man&#46; Nevertheless&#44; a lower dose &#40;10 mg&#47;kg&#47;day&#41;&#44; which would be equivalent to 100 mg&#47;day in a man&#44; was shown to significantly reduce vascular O<span class="elsevierStyleInf">2</span><span class="elsevierStyleGlyphrad"></span><span class="elsevierStyleSup">&#8722;</span> production&#46;<a class="elsevierStyleCrossRef" href="#bib0645"><span class="elsevierStyleSup">42</span></a> These antioxidative properties may account for the cardiovascular benefits of low-dose aspirin&#46;</p><p id="par0335" class="elsevierStylePara elsevierViewall">The impact of lower aspirin doses on BP has been tested in some studies&#46; In young male SHR&#44; the administration of aspirin &#40;10 mg&#47;kg&#41; twice a week for 10 weeks had no effect on SBP&#46;<a class="elsevierStyleCrossRefs" href="#bib0730"><span class="elsevierStyleSup">59&#44;60</span></a> In male Wistar rats&#44; 50 mg&#47;kg aspirin elicited a pressor response that was markedly enhanced by pretreatment with celecoxib&#44; a COX-2 inhibitor&#44; or with zileuton&#44; a 5-LOX inhibitor&#44; or with Boc-2&#44; a LXA<span class="elsevierStyleInf">4</span> receptor antagonist&#46;<a class="elsevierStyleCrossRef" href="#bib0585"><span class="elsevierStyleSup">30</span></a> Furthermore&#44; aspirin increased the serum concentration of ATL 20-fold and the administration of LXA<span class="elsevierStyleInf">4</span> alone significantly decreased BP&#46; Thus&#44; the formation of ATL attenuates the pressor response to aspirin&#44; and drugs that inhibit ATL production enhance the aspirin-induced BP rise&#46;<a class="elsevierStyleCrossRef" href="#bib0585"><span class="elsevierStyleSup">30</span></a> In another study&#44; treatment with aspirin &#40;53&#46;5 mg&#47;kg&#47;day&#41; for seven days did not alter BP in male Wistar rats but significantly reduced BP in stroke-prone SHR compared to vehicle-treated animals&#46;<a class="elsevierStyleCrossRef" href="#bib0740"><span class="elsevierStyleSup">61</span></a> Our group recently assessed the effect of low-dose aspirin &#40;10 mg&#47;kg&#47;day for eight days&#41; alone or in combination with losartan in male WKY and SHR&#46; Regarding the effect of aspirin alone&#44; no significant changes were observed in SBP of WKY or SHR compared to their respective controls&#46;<a class="elsevierStyleCrossRef" href="#bib0745"><span class="elsevierStyleSup">62</span></a> Recently&#44; another study also confirmed the lack of effect of low-dose aspirin &#40;10 mg&#47;kg&#47;day for seven days&#41; on the BP of normotensive WKY&#46;<a class="elsevierStyleCrossRef" href="#bib0750"><span class="elsevierStyleSup">63</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Effects when used in combination with other antihypertensive drugs</span><p id="par0340" class="elsevierStylePara elsevierViewall">The impact on BP of the combination of aspirin with antihypertensive drugs has been little studied&#46; Tuttle et al&#46; studied the antihypertensive efficacy of the BB metoprolol&#44; aspirin &#40;75-100 mg&#47;kg&#47;day&#41;&#44; and their combination for 56 days&#44; in young SHR and WKY&#46; Treatment with metoprolol or aspirin alone prevented BP rise in both WKY and SHR&#46; In contrast&#44; when the drugs were co-administered&#44; a loss of the antihypertensive effect was observed in SHR but not in WKY&#46; Renal PGs were also measured after 56 days of treatment&#46; Whereas renal PG content was higher in older SHR than in age-matched WKY&#44; lower levels were found in SHR receiving aspirin or metoprolol&#46; SHR treated with both drugs also exhibited reduced renal PG content&#44; despite the loss of antihypertensive efficacy&#46; The authors concluded that aspirin and metoprolol attenuate each other&#39;s antihypertensive effect&#44; but could not explain the underlying mechanism based on the changes observed in renal PGs&#46;<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">11</span></a></p><p id="par0345" class="elsevierStylePara elsevierViewall">Our group assessed the effects of combined treatment with low-dose aspirin &#40;10 mg&#47;kg&#47;day for eight days&#41; and the ARB losartan in male SHR and WKY&#46; Although aspirin treatment did not modify the antihypertensive effect of losartan in WKY&#44; it significantly improved the BP-lowering efficacy of losartan in SHR&#46; This effect was associated with a significant reduction in renal COX-2 expression and in the production of vasoconstrictive eicosanoids&#44; compared to SHR treated with losartan alone&#46;<a class="elsevierStyleCrossRefs" href="#bib0745"><span class="elsevierStyleSup">62&#44;64</span></a></p><p id="par0350" class="elsevierStylePara elsevierViewall">The interaction between aspirin and ACEIs was studied in SHR and in rats with methylprednisolone-induced hypertension&#46; In male SHR&#44; treatment with aspirin &#40;200mg&#47;kg&#47;day for seven days&#41; did not alter the antihypertensive effect of captopril&#44; although it markedly inhibited the formation of vasodilator prostanoids&#46; Thus&#44; these prostanoids do not appear to contribute to the antihypertensive effect of captopril in SHR&#46;<a class="elsevierStyleCrossRef" href="#bib0760"><span class="elsevierStyleSup">65</span></a> However&#44; in another study in older SHR&#44; combined treatment with captopril and aspirin &#40;200 mg&#47;kg&#47;day&#41; for seven days enhanced the antihypertensive effect of captopril&#44; apparently by inducing an increase in diuresis&#46; The inhibition of renal PG excretion by aspirin was a transient effect and it was concluded that the enhancement of captopril&#39;s antihypertensive efficacy by aspirin was independent of renal PG excretion&#46;<a class="elsevierStyleCrossRef" href="#bib0765"><span class="elsevierStyleSup">66</span></a> In male Wistar rats with methylprednisolone-induced hypertension&#44; treatment with 25 mg&#47;kg&#47;day or 100 mg&#47;kg&#47;day aspirin did not modify the hypotensive effect of lisinopril&#46; However&#44; cardiac and renal degenerative changes were found even with the lower aspirin dose&#44; and the combination of the higher aspirin dose and lisinopril was associated with a significant increase in mortality compared to hypertensive rats treated with lisinopril alone&#46;<a class="elsevierStyleCrossRef" href="#bib0770"><span class="elsevierStyleSup">67</span></a> A summary of these studies is presented in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Aspirin and blood pressure&#58; studies in humans</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Aspirin and blood pressure in healthy individuals</span><p id="par0355" class="elsevierStylePara elsevierViewall">The influence of aspirin on BP in healthy subjects was investigated in a study designed to assess the effects of captopril&#44; aspirin and the combination of both drugs on BP and on the excretion of prostanoids&#44; nitrates and cyclic guanosine monophosphate &#40;cGMP&#41;&#46; A crossover trial was performed in 13 healthy females aged 24&#46;9&#177;0&#46;5 years who were randomized to receive captopril &#40;25 mg twice a day&#41;&#44; aspirin &#40;100 mg&#47;day&#41; or both drugs for one week&#44; separated by a two-week washout&#46; Aspirin did not change BP when given alone and did not modulate the hypotensive effect of captopril when co-administered&#46; Urinary excretion of PGI<span class="elsevierStyleInf">2</span> metabolite&#44; PGE<span class="elsevierStyleInf">2</span>&#44; nitrate and cGMP was not altered by either treatment but aspirin significantly reduced the excretion of TXA<span class="elsevierStyleInf">2</span> metabolite&#44; when given alone or in combination with captopril&#46;<a class="elsevierStyleCrossRef" href="#bib0775"><span class="elsevierStyleSup">68</span></a></p><p id="par0360" class="elsevierStylePara elsevierViewall">Hermida et al&#46; investigated the administration time- and dose-dependent effects of aspirin on BP in healthy individuals&#46; In their first study&#44; 55 healthy subjects aged 20&#46;9&#177;1&#46;8 years were randomized to receive aspirin &#40;500 mg&#47;day&#41; for one week on awakening &#40;n&#61;18&#41;&#44; during the afternoon &#40;n&#61;26&#41; or at bedtime &#40;n&#61;11&#41;&#46; There was a significant reduction in BP only when aspirin was administered during the afternoon&#46;<a class="elsevierStyleCrossRef" href="#bib0780"><span class="elsevierStyleSup">69</span></a> The same authors also conducted a double-blind&#44; randomized clinical trial with 73 healthy participants &#40;21&#46;3&#177;0&#46;3 years of age&#41; assigned to one of six groups defined according to placebo&#47;aspirin dose &#40;100 or 500 mg&#47;day&#41; for one week and to the circadian time of administration &#40;awakening&#44; afternoon and bedtime&#41;&#46; In subjects receiving 500 mg aspirin&#44; there was a small &#40;approximately 2 mmHg&#41; but significant reduction in SBP and diastolic blood pressure &#40;DBP&#41; when aspirin was given in the afternoon&#46; Treatment with the lower dose in the afternoon elicited a significant SBP and DBP reduction&#44; comparable to that obtained with 500 mg aspirin administered at the same time&#46; However&#44; the BP reduction was larger when 100 mg aspirin was given at bedtime&#46; The higher impact on BP for 100 mg aspirin compared to 500 mg may be related to the selective inhibition of TXA<span class="elsevierStyleInf">2</span> but not PGI<span class="elsevierStyleInf">2</span> with the lower dose&#46; The time dependency of BP reduction by aspirin could be due to circadian rhythms in circulating platelets&#44; platelet aggregation&#44; clotting and fibrinolytic inhibitors&#44; and also in aspirin&#39;s inhibition of platelet aggregation&#46;<a class="elsevierStyleCrossRef" href="#bib0785"><span class="elsevierStyleSup">70</span></a></p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Aspirin and blood pressure in untreated hypertensive patients</span><p id="par0365" class="elsevierStylePara elsevierViewall">Hermida et al&#46; also assessed the administration time-dependency of the effect of 100 mg&#47;day aspirin for one week on BP reduction in untreated hypertensive subjects&#46; This was performed in 18 volunteers aged 21&#46;8&#177;0&#46;4 years&#44; recently diagnosed with mild hypertension and untreated for hypertension&#46; Aspirin significantly decreased BP when administered in the afternoon and at bedtime&#44; but the effect was larger for bedtime administration&#46;<a class="elsevierStyleCrossRef" href="#bib0785"><span class="elsevierStyleSup">70</span></a> The same authors also conducted a trial in 100 untreated volunteers with mild &#40;grade 1&#41; essential hypertension&#44; aged 42&#46;5&#177;11&#46;6 years&#44; who were randomly allocated to three groups to take hygienic-dietary recommendations &#40;HDR&#41; &#40;n&#61;50&#41;&#44; HDR plus aspirin &#40;100 mg&#47;day&#41; on awakening &#40;n&#61;24&#41; or HDR plus aspirin &#40;100 mg&#47;day&#41; before bedtime &#40;n&#61;26&#41; for three months&#46; Essentially&#44; in the group that received aspirin before bedtime&#44; but not in the other groups&#44; there were significant reductions in SBP and DBP measured by conventional methods and by ambulatory blood pressure measurement &#40;ABPM&#41;&#46; Although the mechanisms responsible for this decrease have not been elucidated&#44; the authors speculate that circadian rhythms in TXA<span class="elsevierStyleInf">2</span> production and in plasma renin activity &#40;PRA&#41; could account for the BP lowering effect of aspirin&#46;<a class="elsevierStyleCrossRef" href="#bib0790"><span class="elsevierStyleSup">71</span></a> Hermida et al&#46; also conducted a similar study involving a larger sample of 328 untreated grade 1 hypertensive patients aged 44&#46;0&#177;12&#46;6 years&#46; These subjects were randomly distributed to the same groups described above &#40;HDR&#44; n&#61;169&#59; HDR plus aspirin 100 mg&#47;day on awakening&#44; n&#61;77&#59; HDR plus aspirin 100 mg&#47;day before bedtime&#44; n&#61;82&#41;&#46; The results obtained corroborated the previously described reduction of SBP and DBP values on ABPM and conventional measurement in the group receiving low-dose aspirin at bedtime&#46;<a class="elsevierStyleCrossRef" href="#bib0795"><span class="elsevierStyleSup">72</span></a> They further compared the chronobiological impact of aspirin on BP in dipper and non-dipper subjects with untreated grade 1 hypertension &#40;n&#61;257&#41; randomized to receive aspirin &#40;100 mg&#47;day&#41; on awakening &#40;n&#61;126&#44; 80 dipper and 46 non-dipper&#41; or at bedtime &#40;n&#61;131&#44; 83 dipper and 48 non-dipper&#41; for three months&#46; This study again confirmed that aspirin given at bedtime&#44; but not on awakening&#44; significantly reduced 24-hour SBP and DBP&#46; Of note&#44; aspirin administered at bedtime induced a two-fold higher decrease in nocturnal BP in non-dipper patients compared to dipper patients&#46;<a class="elsevierStyleCrossRef" href="#bib0800"><span class="elsevierStyleSup">73</span></a> Interestingly&#44; in another study they also demonstrated the existence of gender differences in BP response to aspirin administration&#46; This trial included 130 men and 186 women with untreated grade 1 hypertension who were randomly assigned to take aspirin 100 mg&#47;day on awakening or at bedtime for three months&#46;<a class="elsevierStyleCrossRef" href="#bib0805"><span class="elsevierStyleSup">74</span></a> When aspirin was administered on awakening&#44; BP was not altered in men but was slightly increased in women&#46; In contrast&#44; when aspirin was given at bedtime&#44; BP values were significantly decreased in both men and women&#46; This reduction was significantly larger in women than in men&#44; and gender differences in BP were greater during night-time rest&#46;<a class="elsevierStyleCrossRef" href="#bib0805"><span class="elsevierStyleSup">74</span></a></p><p id="par0370" class="elsevierStylePara elsevierViewall">Magagna et al&#46; also assessed the influence of 100 mg&#47;day aspirin on BP control in untreated borderline or mild essential hypertensive subjects&#46; Ten patients aged 47&#46;9&#177;5&#46;1 years received aspirin &#40;100 mg&#47;day&#41; or placebo for four weeks&#46; Aspirin treatment did not modify BP in these patients but significantly reduced serum and urinary TXB<span class="elsevierStyleInf">2</span> and PRA&#46;<a class="elsevierStyleCrossRef" href="#bib0810"><span class="elsevierStyleSup">75</span></a> Although urinary excretion of PGI<span class="elsevierStyleInf">2</span> metabolite was not significantly altered by aspirin treatment&#44; the authors reported that it was slightly decreased and could have contributed to the reduction in PRA&#46;<a class="elsevierStyleCrossRef" href="#bib0810"><span class="elsevierStyleSup">75</span></a> The effect on BP of low-dose aspirin in untreated hypertensive patients was further studied by Snoep et al&#46; as a secondary endpoint in a crossover trial designed to assess the mechanisms underlying BP reduction when aspirin was given at bedtime&#46;<a class="elsevierStyleCrossRef" href="#bib0815"><span class="elsevierStyleSup">76</span></a> This trial included 16 untreated grade 1 hypertensive individuals aged 58&#46;4&#177;6&#46;8 years who were randomly allocated to one of two groups&#44; one receiving aspirin &#40;100 mg&#47;day&#41; at bedtime and placebo on awakening&#44; and the other receiving aspirin on awakening and placebo at bedtime&#44; for two weeks&#46; After a four-week washout interval&#44; patients again received aspirin and placebo for another two weeks&#44; in the reverse order of the first treatment period&#46; The results of this study indicate that aspirin intake at bedtime compared with the morning significantly reduced PRA over 24 hours&#44; as well as 24-hour urinary excretion of cortisol&#44; dopamine and noradrenaline&#46; The authors suggested that reduced activity of these pressor systems was a plausible explanation for the BP decrease when aspirin is given at night and the lack of effect detected when given in the morning&#46; Although in this study no significant reduction in 24-hour BP was observed when aspirin was given at bedtime&#44; the authors hypothesized that the treatment period was probably too short to translate the effects on BP regulating systems into effective BP reduction&#46; They also underlined that their study was not designed and powered to detect differences in BP response to timed administration of aspirin&#46;<a class="elsevierStyleCrossRef" href="#bib0815"><span class="elsevierStyleSup">76</span></a></p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Aspirin and blood pressure in subjects at elevated risk for developing hypertension</span><p id="par0375" class="elsevierStylePara elsevierViewall">In addition to these studies in subjects with mild hypertension&#44; Hermida et al&#46; also compared the BP effects of different administration times &#40;awakening&#44; afternoon or bedtime&#41; of low-dose aspirin &#40;100 mg&#47;day&#41; in pregnant women at higher risk for gestational hypertension or preeclampsia&#46;<a class="elsevierStyleCrossRefs" href="#bib0820"><span class="elsevierStyleSup">77&#8211;79</span></a> The results obtained in these trials corroborate previous findings in healthy and untreated mild hypertensive subjects&#44;<a class="elsevierStyleCrossRef" href="#bib0785"><span class="elsevierStyleSup">70</span></a> i&#46;e&#46;&#44; BP was significantly reduced when aspirin was administered in the afternoon and this effect was even greater when it was given at bedtime&#46; There was no significant change in BP when aspirin was administered on awakening&#46;<a class="elsevierStyleCrossRefs" href="#bib0820"><span class="elsevierStyleSup">77&#8211;79</span></a></p><p id="par0380" class="elsevierStylePara elsevierViewall">Similar results were obtained in another study by the same group involving 244 individuals aged 43&#46;0&#177;13&#46;0 years with prehypertension randomly distributed to one of three groups &#40;non-pharmacological recommendations&#59; the same recommendations and aspirin 100 mg&#47;day on awakening&#59; and the same recommendations and aspirin 100 mg&#47;day at bedtime&#41;&#46; Once again&#44; a significant BP reduction was observed only when aspirin was given at bedtime&#46;<a class="elsevierStyleCrossRef" href="#bib0835"><span class="elsevierStyleSup">80</span></a></p><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Aspirin and blood pressure in treated hypertensive patients</span><p id="par0385" class="elsevierStylePara elsevierViewall">The majority of small&#44; short-term trials have reported that low doses &#40;75-100 mg&#47;day&#41; of aspirin do not interfere with the BP lowering effect of ACEIs &#40;captopril&#44; enalapril&#41;&#44; ARBs &#40;losartan&#41;&#44; BBs &#40;atenolol&#41; and calcium antagonists &#40;nifedipine&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0485"><span class="elsevierStyleSup">10&#44;14&#44;19&#44;75&#44;81&#44;82</span></a> Regarding the interaction of low-dose aspirin and ACEIs&#44; although no change in the antihypertensive effect of ACEIs was detected&#44; significant reductions in serum and&#47;or urinary TXB<span class="elsevierStyleInf">2</span> were observed with combined treatment with aspirin compared with treatment with ACEIs alone&#46;<a class="elsevierStyleCrossRefs" href="#bib0505"><span class="elsevierStyleSup">14&#44;75&#44;81</span></a> Nevertheless&#44; no significant changes were observed in the urinary metabolite of PGI<span class="elsevierStyleInf">2</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0810"><span class="elsevierStyleSup">75</span></a> Studies assessing the effects of higher aspirin doses on the BP of patients treated with ACEIs have reported contradictory results&#46; While Guazzi et al&#46; showed that aspirin &#40;300 mg&#47;day&#41; induced an antagonistic effect on the action of enalapril&#44;<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">10</span></a> Nawarskas et al&#46; observed no significant changes in mean arterial pressure&#44; SBP or DBP in patients treated with aspirin &#40;325 mg&#41; and enalapril&#44; compared to enalapril alone&#46;<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">14</span></a> Furthermore&#44; Fisman et al&#46; reported that treatment with aspirin 500 mg&#47;day for one week did not influence BP control in hypertensive or in post-infarction patients receiving an ACEI&#46;<a class="elsevierStyleCrossRef" href="#bib0850"><span class="elsevierStyleSup">83</span></a> Also of note is the fact that combined treatment with aspirin &#40;100 and&#47;or 300 mg&#47;day&#41; and ACEIs reduced the ACEI-induced increased in PRA&#46;<a class="elsevierStyleCrossRefs" href="#bib0485"><span class="elsevierStyleSup">10&#44;75</span></a></p><p id="par0390" class="elsevierStylePara elsevierViewall">The interaction of aspirin with ARBs does not appear to negatively influence BP control&#46; No significant BP differences were observed when losartan was associated with aspirin therapy &#40;81 mg or 325 mg&#47;day&#41; for two weeks&#46;<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">14</span></a> Of note&#44; a post-hoc subgroup analysis of the Losartan Intervention For Endpoint reduction in hypertension &#40;LIFE&#41; study revealed that the combination of aspirin with losartan exerted greater cardiovascular protection than the combination of aspirin with atenolol&#44; despite similar BP reduction&#46;<a class="elsevierStyleCrossRef" href="#bib0510"><span class="elsevierStyleSup">15</span></a> Additionally&#44; a significant decrease in cardiovascular events was found in patients using aspirin plus losartan&#44; compared with losartan alone&#46;<a class="elsevierStyleCrossRef" href="#bib0510"><span class="elsevierStyleSup">15</span></a> Interestingly&#44; Prikryl et al&#46; showed that the addition of aspirin to telmisartan improved the effects of this ARB on BP&#44; heart rate&#44; intrarenal resistive index and ejection fraction&#46;<a class="elsevierStyleCrossRef" href="#bib0855"><span class="elsevierStyleSup">84</span></a></p><p id="par0395" class="elsevierStylePara elsevierViewall">There have also been large and medium- or long-term trials assessing the BP effects of aspirin in patients on antihypertensive monotherapy or combination therapy &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; Avanzini et al&#46; reported that there was no significant change in BP after addition of aspirin &#40;100 mg&#47;day&#41; to antihypertensive therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">13</span></a> Results from the Hypertension Optimal Treatment &#40;HOT&#41; randomized trial also revealed that there were no differences in achieved BP in patients randomized to aspirin or placebo&#46;<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">4</span></a> Importantly&#44; the combination of aspirin with antihypertensive treatment reduced the risk of acute myocardial infarction without increasing the risk of cerebral bleeding&#46;<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">4</span></a> Furthermore&#44; the BP values achieved&#44; the intensity of the antihypertensive regimen&#44; and the number and type of drugs used were very similar in aspirin and placebo patients&#44; not only in the overall HOT study population&#44; but in all subgroups&#46;<a class="elsevierStyleCrossRef" href="#bib0860"><span class="elsevierStyleSup">85</span></a> Of note&#44; Leinonen et al&#46; conducted a large observational study to assess the effect of aspirin treatment &#40;50-250 mg&#47;day&#41; on BP of hypertensive patients receiving antihypertensive monotherapy or combination therapy and observed that aspirin reduced DBP regardless of the antihypertensive therapeutic scheme&#46;<a class="elsevierStyleCrossRef" href="#bib0545"><span class="elsevierStyleSup">22</span></a></p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0400" class="elsevierStylePara elsevierViewall">The chronotherapeutic effects of aspirin have also been investigated in treated hypertensive patients &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; The administration time-dependent effects of aspirin were assessed in patients with long-standing hypertension and treated with aspirin for cardiovascular prevention&#46; Hypertensive patients were randomly assigned to take aspirin &#40;75-160 mg&#47;day&#41; in the morning followed by aspirin in the evening&#44; or in the reverse order&#44; during two one-month periods&#44; with no washout period&#46; No differences were found in mean 24-hour SBP or DBP&#44; or in patients&#8217; dipper&#47;non-dipper status&#44; independently of aspirin administration time&#46;<a class="elsevierStyleCrossRef" href="#bib0865"><span class="elsevierStyleSup">86</span></a> The timing effect of aspirin dosing on BP was further studied in a recent crossover trial including patients taking low-dose aspirin for secondary cardiovascular disease prevention&#46; Subjects were randomized to receive aspirin on awakening then at bedtime&#44; or the reverse order&#44; during two three-month periods&#44; with no washout period&#46; No differences were found in mean 24-hour SBP or DBP when aspirin was administered at awakening or at bedtime&#46; However&#44; morning platelet reactivity was significantly reduced when aspirin was taken at bedtime&#46;<a class="elsevierStyleCrossRef" href="#bib0870"><span class="elsevierStyleSup">87</span></a> These results<a class="elsevierStyleCrossRefs" href="#bib0865"><span class="elsevierStyleSup">86&#44;87</span></a> contradict those observed for bedtime aspirin administration in patients with untreated mild hypertension or those at risk of developing hypertension&#44;<a class="elsevierStyleCrossRefs" href="#bib0785"><span class="elsevierStyleSup">70&#8211;73&#44;77&#8211;80</span></a> and may be explained by differences in study populations or by a weakened chronopharmacological effect of aspirin in patients taking this drug for a long time&#46;<a class="elsevierStyleCrossRefs" href="#bib0865"><span class="elsevierStyleSup">86&#44;87</span></a> A summary of studies assessing aspirin&#39;s effects in treated hypertensive patients is presented in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46;</p></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclusions</span><p id="par0405" class="elsevierStylePara elsevierViewall">Besides its well-known antithrombotic effect&#44; aspirin exerts protective effects on redox status and vascular reactivity and triggers the synthesis of SPMs from AA and omega-3 fatty acids&#44; which may account for its overall cardiovascular benefits&#46;</p><p id="par0410" class="elsevierStylePara elsevierViewall">Most studies assessing aspirin&#39;s effects on BP in experimental and human hypertension indicate that&#44; when used in low doses&#44; aspirin by itself does not affect BP values and does not counteract the BP-lowering efficacy of antihypertensive drugs&#46; Of note&#44; combined treatment with ARBs and aspirin appears to improve cardiovascular protection&#44; compared to ARBs alone&#46; Nevertheless&#44; experimental studies assessing aspirin&#39;s interaction with antihypertensive drugs are scarce and have done little to identify the mechanisms underlying its protective or deleterious effects&#46;</p><p id="par0415" class="elsevierStylePara elsevierViewall">In subjects with long-standing hypertension and treated with antihypertensive drugs&#44; the time of aspirin administration does not seem to affect BP control&#44; although bedtime intake might exert stronger protection against cardiovascular events due to its significant effect in lowering morning platelet reactivity&#46;</p><p id="par0420" class="elsevierStylePara elsevierViewall">In conclusion&#44; low doses of aspirin do not negatively influence BP control by antihypertensive drugs and appear to enhance cardiovascular protection when associated with ARBs&#46; Further studies are needed to elucidate the mechanisms responsible for these effects&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Funding</span><p id="par0425" class="elsevierStylePara elsevierViewall">This work was supported by FEDER funds via <span class="elsevierStyleGrantSponsor" id="gs1">COMPETE</span> and by national funds through <span class="elsevierStyleGrantSponsor" id="gs2">FCT</span> &#8211; Portuguese Foundation for Science and Technology &#40;project grants&#58; <span class="elsevierStyleGrantNumber" refid="gs2">PTDC&#47;SAU-TOX&#47;114166&#47;2009</span> and <span class="elsevierStyleGrantNumber" refid="gs2">EXPL&#47;IVC-PEC&#47;1302&#47;2013</span>&#41;&#46; Teresa Sousa was also funded by FCT &#40;<span class="elsevierStyleGrantNumber" refid="gs2">SFRH&#47;BPD&#47;112005&#47;2015</span>&#41;&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Ethical disclosures</span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Protection of human and animal subjects</span><p id="par0430" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Confidentiality of data</span><p id="par0435" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Right to privacy and informed consent</span><p id="par0440" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflicts of interest</span><p id="par0445" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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          "titulo" => "Introduction"
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          "titulo" => "Aspirin and inhibition of cyclooxygenase-1 and cyclooxygenase-2"
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          "titulo" => "Aspirin and production of pro-resolving lipid mediators"
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          "titulo" => "Aspirin and blood pressure&#58; studies in experimental models of hypertension"
          "secciones" => array:2 [
            0 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Effects when used alone"
            ]
            1 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Effects when used in combination with other antihypertensive drugs"
            ]
          ]
        ]
        10 => array:3 [
          "identificador" => "sec0045"
          "titulo" => "Aspirin and blood pressure&#58; studies in humans"
          "secciones" => array:2 [
            0 => array:2 [
              "identificador" => "sec0050"
              "titulo" => "Aspirin and blood pressure in healthy individuals"
            ]
            1 => array:2 [
              "identificador" => "sec0055"
              "titulo" => "Aspirin and blood pressure in untreated hypertensive patients"
            ]
          ]
        ]
        11 => array:3 [
          "identificador" => "sec0060"
          "titulo" => "Aspirin and blood pressure in subjects at elevated risk for developing hypertension"
          "secciones" => array:1 [
            0 => array:2 [
              "identificador" => "sec0065"
              "titulo" => "Aspirin and blood pressure in treated hypertensive patients"
            ]
          ]
        ]
        12 => array:2 [
          "identificador" => "sec0070"
          "titulo" => "Conclusions"
        ]
        13 => array:2 [
          "identificador" => "sec0075"
          "titulo" => "Funding"
        ]
        14 => array:3 [
          "identificador" => "sec0080"
          "titulo" => "Ethical disclosures"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0085"
              "titulo" => "Protection of human and animal subjects"
            ]
            1 => array:2 [
              "identificador" => "sec0090"
              "titulo" => "Confidentiality of data"
            ]
            2 => array:2 [
              "identificador" => "sec0095"
              "titulo" => "Right to privacy and informed consent"
            ]
          ]
        ]
        15 => array:2 [
          "identificador" => "sec0100"
          "titulo" => "Conflicts of interest"
        ]
        16 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2017-04-13"
    "fechaAceptado" => "2017-05-22"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec862183"
          "palabras" => array:5 [
            0 => "Aspirin"
            1 => "Pharmacologic actions"
            2 => "Blood pressure"
            3 => "Hypertension"
            4 => "Antihypertensive agents"
          ]
        ]
      ]
      "pt" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras-chave"
          "identificador" => "xpalclavsec862184"
          "palabras" => array:5 [
            0 => "Aspirina"
            1 => "A&#231;&#245;es farmacol&#243;gicas"
            2 => "Press&#227;o arterial"
            3 => "Hipertens&#227;o"
            4 => "F&#225;rmacos anti-hipertensores"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Arterial hypertension is a major risk factor for cardiovascular and renal events&#46; Lowering blood pressure is thus an important strategy for reducing morbidity and mortality&#46; Since low-dose aspirin is a cornerstone in the prevention of adverse cardiovascular outcomes&#44; combined treatment with aspirin and antihypertensive drugs is very common&#46; However&#44; the impact of aspirin therapy on blood pressure control remains a subject of intense debate&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Recent data suggest that the cardioprotective action of aspirin extends beyond its well-known antithrombotic effect&#46; Aspirin has been shown to trigger the synthesis of specialized pro-resolving lipid mediators from arachidonic acid and omega-3 fatty acids&#46; These novel anti-inflammatory and pro-resolving mediators actively stimulate the resolution of inflammation and tissue regeneration&#46; Additionally&#44; they may contribute to other protective effects on redox status and vascular reactivity that have also been attributed to aspirin&#46; Of note&#44; aspirin has been shown to improve vasodilation through cyclooxygenase-independent mechanisms&#46; On the other hand&#44; higher aspirin doses have been reported to exert a negative impact on blood pressure due to inhibition of cyclooxygenase-2 activity&#44; which reduces renal blood flow&#44; glomerular filtration rate and sodium and water excretion&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">This review aims to provide an overview of the effects of aspirin on blood pressure and the underlying mechanisms&#44; focusing on the interaction between aspirin and antihypertensive drugs&#46; Studies in both experimental and human hypertension are presented&#46;</p></span>"
      ]
      "pt" => array:2 [
        "titulo" => "Resumo"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A hipertens&#227;o arterial representa um fator de risco <span class="elsevierStyleItalic">major</span> para eventos cardiovasculares e renais&#46; Por esse motivo&#44; a redu&#231;&#227;o da press&#227;o arterial &#233; uma estrat&#233;gia importante para a diminui&#231;&#227;o da morbilidade e mortalidade&#46; Como a aspirina em dose baixa constitui a terap&#234;utica base na preven&#231;&#227;o de eventos cardiovasculares&#44; a sua associa&#231;&#227;o com f&#225;rmacos anti-hipertensores &#233; muito comum&#46; No entanto&#44; o impacto da aspirina no controlo da press&#227;o arterial permanece um tema de intensa discuss&#227;o&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Estudos recentes sugerem que a a&#231;&#227;o cardioprotetora da aspirina n&#227;o est&#225; limitada ao seu conhecido efeito antitromb&#243;tico&#46; A aspirina ativa a s&#237;ntese de mediadores pr&#243;-resolutivos especializados a partir do &#225;cido araquid&#243;nico e de &#225;cidos gordos &#243;mega-3&#46; Estes novos mediadores anti-inflamat&#243;rios e pr&#243;-resolutivos estimulam ativamente a resolu&#231;&#227;o da inflama&#231;&#227;o e a regenera&#231;&#227;o tecidual&#46; Adicionalmente&#44; poder&#227;o contribuir para os efeitos protetores no estado <span class="elsevierStyleItalic">redox</span> e na reatividade vascular que t&#234;m sido atribu&#237;dos &#224; aspirina&#46; &#201; de sublinhar que a aspirina parece tamb&#233;m melhorar a vasodilata&#231;&#227;o por mecanismos independentes da inibi&#231;&#227;o da cicloxigenase&#46; Por outro lado&#44; o uso de aspirina em doses altas parece exercer um efeito negativo na press&#227;o arterial devido &#224; inibi&#231;&#227;o da atividade da cicloxigenase-2 e consequente redu&#231;&#227;o do fluxo sangu&#237;neo renal&#44; da taxa de filtra&#231;&#227;o glomerular e da excre&#231;&#227;o de s&#243;dio e &#225;gua&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Este artigo pretende rever os efeitos da aspirina na press&#227;o arterial e mecanismos subjacentes&#44; com enfoque na intera&#231;&#227;o entre a aspirina e os f&#225;rmacos anti-hipertensores&#46; S&#227;o apresentados estudos na hipertens&#227;o experimental e humana&#46;</p></span>"
      ]
    ]
    "nomenclatura" => array:1 [
      0 => array:3 [
        "identificador" => "nom0005"
        "titulo" => "<span class="elsevierStyleSectionTitle" id="sect0025">List of abbreviations</span>"
        "listaDefinicion" => array:1 [
          0 => array:1 [
            "definicion" => array:55 [
              0 => array:2 [
                "termino" => "15-epi-LXA4"
                "descripcion" => "<p id="par0005" class="elsevierStylePara elsevierViewall">15R-epimeric lipoxin A4</p>"
              ]
              1 => array:2 [
                "termino" => "15-epi-LXB4"
                "descripcion" => "<p id="par0010" class="elsevierStylePara elsevierViewall">15R-epimeric lipoxin B4</p>"
              ]
              2 => array:2 [
                "termino" => "15-epi-LXs"
                "descripcion" => "<p id="par0015" class="elsevierStylePara elsevierViewall">15-epi-lipoxins</p>"
              ]
              3 => array:2 [
                "termino" => "15R-HETE"
                "descripcion" => "<p id="par0020" class="elsevierStylePara elsevierViewall">15&#40;R&#41;-hydroxyeicosatetraenoic acid</p>"
              ]
              4 => array:2 [
                "termino" => "17R-HDHA"
                "descripcion" => "<p id="par0025" class="elsevierStylePara elsevierViewall">17R-hydroxydocosahexaenoic acid</p>"
              ]
              5 => array:2 [
                "termino" => "18R-HETE"
                "descripcion" => "<p id="par0030" class="elsevierStylePara elsevierViewall">18R-hydroxyeicosapentaenoic acid</p>"
              ]
              6 => array:2 [
                "termino" => "5-LOX"
                "descripcion" => "<p id="par0035" class="elsevierStylePara elsevierViewall">5-lipoxygenase</p>"
              ]
              7 => array:2 [
                "termino" => "AA"
                "descripcion" => "<p id="par0040" class="elsevierStylePara elsevierViewall">arachidonic acid</p>"
              ]
              8 => array:2 [
                "termino" => "ABPM"
                "descripcion" => "<p id="par0045" class="elsevierStylePara elsevierViewall">ambulatory blood pressure measurement</p>"
              ]
              9 => array:2 [
                "termino" => "ACEI"
                "descripcion" => "<p id="par0050" class="elsevierStylePara elsevierViewall">angiotensin-converting enzyme inhibitors</p>"
              ]
              10 => array:2 [
                "termino" => "Ang II"
                "descripcion" => "<p id="par0055" class="elsevierStylePara elsevierViewall">angiotensin II</p>"
              ]
              11 => array:2 [
                "termino" => "ARB"
                "descripcion" => "<p id="par0060" class="elsevierStylePara elsevierViewall">angiotensin receptor blockers</p>"
              ]
              12 => array:2 [
                "termino" => "AT-PD"
                "descripcion" => "<p id="par0450" class="elsevierStylePara elsevierViewall">aspirin triggered protectin</p>"
              ]
              13 => array:2 [
                "termino" => "AT-RvD1"
                "descripcion" => "<p id="par0455" class="elsevierStylePara elsevierViewall">aspirin triggered resolvin D1</p>"
              ]
              14 => array:2 [
                "termino" => "AT-RvD2"
                "descripcion" => "<p id="par0460" class="elsevierStylePara elsevierViewall">aspirin triggered resolvin D2</p>"
              ]
              15 => array:2 [
                "termino" => "AT-RvD3"
                "descripcion" => "<p id="par0465" class="elsevierStylePara elsevierViewall">aspirin triggered resolvin D3</p>"
              ]
              16 => array:2 [
                "termino" => "AT-RvD4"
                "descripcion" => "<p id="par0470" class="elsevierStylePara elsevierViewall">aspirin triggered resolvin D4</p>"
              ]
              17 => array:2 [
                "termino" => "ATL"
                "descripcion" => "<p id="par0065" class="elsevierStylePara elsevierViewall">aspirin-triggered lipoxins</p>"
              ]
              18 => array:2 [
                "termino" => "BB"
                "descripcion" => "<p id="par0070" class="elsevierStylePara elsevierViewall">beta-blockers</p>"
              ]
              19 => array:2 [
                "termino" => "BP"
                "descripcion" => "<p id="par0475" class="elsevierStylePara elsevierViewall">blood pressure</p>"
              ]
              20 => array:2 [
                "termino" => "cGMP"
                "descripcion" => "<p id="par0075" class="elsevierStylePara elsevierViewall">cyclic guanosine monophosphate</p>"
              ]
              21 => array:2 [
                "termino" => "COX-1"
                "descripcion" => "<p id="par0080" class="elsevierStylePara elsevierViewall">cyclooxygenase-1</p>"
              ]
              22 => array:2 [
                "termino" => "COX-2"
                "descripcion" => "<p id="par0085" class="elsevierStylePara elsevierViewall">cyclooxygenase-2</p>"
              ]
              23 => array:2 [
                "termino" => "DBP"
                "descripcion" => "<p id="par0090" class="elsevierStylePara elsevierViewall">diastolic blood pressure</p>"
              ]
              24 => array:2 [
                "termino" => "DHA"
                "descripcion" => "<p id="par0095" class="elsevierStylePara elsevierViewall">docosahexaenoic acid</p>"
              ]
              25 => array:2 [
                "termino" => "eNOS"
                "descripcion" => "<p id="par0100" class="elsevierStylePara elsevierViewall">endothelial nitric oxide synthase</p>"
              ]
              26 => array:2 [
                "termino" => "EPA"
                "descripcion" => "<p id="par0105" class="elsevierStylePara elsevierViewall">eicosapentaenoic acid</p>"
              ]
              27 => array:2 [
                "termino" => "HDR"
                "descripcion" => "<p id="par0110" class="elsevierStylePara elsevierViewall">hygienic-dietary recommendations</p>"
              ]
              28 => array:2 [
                "termino" => "HOT"
                "descripcion" => "<p id="par0115" class="elsevierStylePara elsevierViewall">Hypertension Optimal Treatment</p>"
              ]
              29 => array:2 [
                "termino" => "LIFE"
                "descripcion" => "<p id="par0120" class="elsevierStylePara elsevierViewall">Losartan Intervention For Endpoint reduction in hypertension</p>"
              ]
              30 => array:2 [
                "termino" => "LOX"
                "descripcion" => "<p id="par0125" class="elsevierStylePara elsevierViewall">lipoxygenase</p>"
              ]
              31 => array:2 [
                "termino" => "LXs"
                "descripcion" => "<p id="par0130" class="elsevierStylePara elsevierViewall">lipoxins</p>"
              ]
              32 => array:2 [
                "termino" => "NADPH oxidase"
                "descripcion" => "<p id="par0135" class="elsevierStylePara elsevierViewall">nicotinamide adenine dinucleotide phosphate oxidase</p>"
              ]
              33 => array:2 [
                "termino" => "NF&#954;B"
                "descripcion" => "<p id="par0480" class="elsevierStylePara elsevierViewall">nuclear factor kappa B</p>"
              ]
              34 => array:2 [
                "termino" => "NO"
                "descripcion" => "<p id="par0140" class="elsevierStylePara elsevierViewall">nitric oxide</p>"
              ]
              35 => array:2 [
                "termino" => "NSAIDs"
                "descripcion" => "<p id="par0145" class="elsevierStylePara elsevierViewall">nonsteroidal anti-inflammatory drugs</p>"
              ]
              36 => array:2 [
                "termino" => "O<span class="elsevierStyleInf">2</span><span class="elsevierStyleGlyphrad"></span><span class="elsevierStyleSup">&#8722;</span>"
                "descripcion" => "<p id="par0150" class="elsevierStylePara elsevierViewall">superoxide</p>"
              ]
              37 => array:2 [
                "termino" => "PDs"
                "descripcion" => "<p id="par0155" class="elsevierStylePara elsevierViewall">protectins</p>"
              ]
              38 => array:2 [
                "termino" => "PGE2"
                "descripcion" => "<p id="par0160" class="elsevierStylePara elsevierViewall">prostaglandin E2</p>"
              ]
              39 => array:2 [
                "termino" => "PGI2"
                "descripcion" => "<p id="par0165" class="elsevierStylePara elsevierViewall">prostacyclin</p>"
              ]
              40 => array:2 [
                "termino" => "PGs"
                "descripcion" => "<p id="par0170" class="elsevierStylePara elsevierViewall">prostaglandins</p>"
              ]
              41 => array:2 [
                "termino" => "PRA"
                "descripcion" => "<p id="par0175" class="elsevierStylePara elsevierViewall">plasma renin activity</p>"
              ]
              42 => array:2 [
                "termino" => "PYK2"
                "descripcion" => "<p id="par0180" class="elsevierStylePara elsevierViewall">proline-rich tyrosine kinase 2</p>"
              ]
              43 => array:2 [
                "termino" => "ROS"
                "descripcion" => "<p id="par0185" class="elsevierStylePara elsevierViewall">reactive oxygen species</p>"
              ]
              44 => array:2 [
                "termino" => "RvE1"
                "descripcion" => "<p id="par0485" class="elsevierStylePara elsevierViewall">resolvin E1</p>"
              ]
              45 => array:2 [
                "termino" => "RvE2"
                "descripcion" => "<p id="par0490" class="elsevierStylePara elsevierViewall">resolvin E2</p>"
              ]
              46 => array:2 [
                "termino" => "Rvs"
                "descripcion" => "<p id="par0190" class="elsevierStylePara elsevierViewall">resolvins</p>"
              ]
              47 => array:2 [
                "termino" => "SBP"
                "descripcion" => "<p id="par0195" class="elsevierStylePara elsevierViewall">systolic blood pressure</p>"
              ]
              48 => array:2 [
                "termino" => "SHR"
                "descripcion" => "<p id="par0200" class="elsevierStylePara elsevierViewall">spontaneously hypertensive rats</p>"
              ]
              49 => array:2 [
                "termino" => "SD"
                "descripcion" => "<p id="par0205" class="elsevierStylePara elsevierViewall">Sprague Dawley</p>"
              ]
              50 => array:2 [
                "termino" => "SMC"
                "descripcion" => "<p id="par0210" class="elsevierStylePara elsevierViewall">smooth muscle cells</p>"
              ]
              51 => array:2 [
                "termino" => "SPMs"
                "descripcion" => "<p id="par0215" class="elsevierStylePara elsevierViewall">specialized pro-resolving lipid mediators</p>"
              ]
              52 => array:2 [
                "termino" => "TXA2"
                "descripcion" => "<p id="par0220" class="elsevierStylePara elsevierViewall">thromboxane A2</p>"
              ]
              53 => array:2 [
                "termino" => "TXB2"
                "descripcion" => "<p id="par0225" class="elsevierStylePara elsevierViewall">thromboxane B2</p>"
              ]
              54 => array:2 [
                "termino" => "WKY"
                "descripcion" => "<p id="par0230" class="elsevierStylePara elsevierViewall">Wistar-Kyoto rats</p>"
              ]
            ]
          ]
        ]
      ]
    ]
    "multimedia" => array:6 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Biosynthesis of aspirin-triggered lipoxins&#46; 5-LOX&#58; 5-lipoxygenase&#59; 15-epi-LXs&#58; 15-epi-lipoxins&#59; 15R-HETE&#58; 15R-hydroxyeicosatetraenoic acid&#59; AA&#58; arachidonic acid&#59; ATL&#58; aspirin-triggered lipoxins&#59; COX-2&#58; cyclooxygenase-2&#46;</p>"
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      1 => array:7 [
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        "tipo" => "MULTIMEDIAFIGURA"
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          "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Biosynthesis of aspirin-triggered resolvins and protectin&#46; 5-LOX&#58; 5-lipoxygenase&#59; 17R-HDHA&#58; 17R-hydroxydocosahexaenoic acid&#59; 18R-HETE&#58; 18R-hydroxyeicosapentaenoic acid&#59; AT-RvD1&#58; aspirin-triggered resolvin D1&#59; AT-RvD2&#58; aspirin-triggered resolvin D2&#59; AT-RvD3&#58; aspirin-triggered resolvin D3&#59; AT-RvD4&#58; aspirin-triggered resolvin D4&#59; AT-PD&#58; aspirin-triggered protectin D&#59; COX-2&#58; cyclooxygenase-2&#59; DHA&#58; docosahexaenoic acid&#59; EPA&#58; eicosapentaenoic acid&#59; RvE1&#58; resolvin E1&#59; RvE2&#58; resolvin E2&#46;</p>"
        ]
      ]
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        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Major protective effects of low-dose aspirin&#46; AA&#58; arachidonic acid&#59; ATL&#58; aspirin-triggered lipoxin&#59; COX-1&#58; cyclooxygenase-1&#59; COX-2&#58; cyclooxygenase-2&#59; eNOS&#58; endothelial nitric oxide synthase&#59; NO&#58; nitric oxide&#59; PD&#58; protectin&#59; Rvs&#58; resolvins&#59; TXA<span class="elsevierStyleInf">2</span>&#58; thromboxane A<span class="elsevierStyleInf">2</span>&#46;</p>"
        ]
      ]
      3 => array:7 [
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        "etiqueta" => "Figure 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
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        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Major protective effects of medium&#47;high-dose aspirin&#46; COX-2&#58; cyclooxygenase-2&#59; NF-&#954;B&#58; nuclear factor kappa B&#59; PGE2&#58; prostaglandin E<span class="elsevierStyleInf">2</span>&#59; PYK2&#58; proline-rich tyrosine kinase 2&#59; TXA<span class="elsevierStyleInf">2</span>&#58; thromboxane A<span class="elsevierStyleInf">2</span>&#46;</p>"
        ]
      ]
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        "etiqueta" => "Table 1"
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">&#8593;&#58; increase&#91;d&#93;&#59; &#8595;&#58; decrease&#91;d&#93;&#59; AA&#58; arachidonic acid&#59; BP&#58; blood pressure&#59; COX-2&#58; cyclooxygenase-2&#59; PG&#58; prostaglandins&#59; SHR&#58; spontaneously hypertensive rats&#59; WKY&#58; Wistar-Kyoto rats&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total no&#46; of rats&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No&#46; of rats taking aspirin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Aspirin dose&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Duration of aspirin treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Antihypertensive treatment&#47;dose&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Effect of combined aspirin treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Other effects&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">DiNicolantonio et al&#46;<a class="elsevierStyleCrossRef" href="#bib0760"><span class="elsevierStyleSup">65</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32 male SHR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 &#40;8 with aspirin&#59; 8 with aspirin&#43;captopril&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11-15 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">200 mg&#47;kg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Captopril<br>30 mg&#47;kg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No significant change in antihypertensive effect&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8595; production of vasodilator prostanoids from exogenous AA with aspirin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tuttle et al&#46;<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">11</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31 male SHR<br>31 male WKY&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25 SHR<br>25 WKY&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">75-100 mg&#47;kg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">56 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Metoprolol<br>0&#46;75-1&#46;0 mg&#47;kg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Loss of the antihypertensive effect in SHR but not in WKY&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Metoprolol or aspirin alone prevented BP rise in WKY and SHR<br>&#8593; renal PG content &#40;PGF<span class="elsevierStyleInf">1&#945;</span>&#43;PGF<span class="elsevierStyleInf">2&#945;</span>&#41; in older SHR &#40;vs&#46; age-matched WKY&#41;<br>&#8595; renal PG content was found in SHR receiving aspirin&#44; metoprolol or both&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Quilley et al&#46;<a class="elsevierStyleCrossRef" href="#bib0765"><span class="elsevierStyleSup">66</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">40 male SHR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8-10 rats with aspirin&#59; 8-10 rats with aspirin&#43;captopril&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20-40 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">200 mg&#47;kg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Captopril<br>30 mg&#47;kg twice&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aspirin &#8593; the antihypertensive effect of captopril&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aspirin &#8593; urine flow in SHR treated with captopril&#43;aspirin &#40;vs&#46; captopril alone&#41;<br>&#8595; in renal PG excretion only in the first 4 hours of aspirin administration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dubey et al&#46;<a class="elsevierStyleCrossRef" href="#bib0770"><span class="elsevierStyleSup">67</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24 male Wistar normotensive rats<br>32 male Wistar hypertensive rats induced by methylprednisolone<br>&#40;20 mg&#47;kg per week&#44; for 2 weeks&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Adults&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25 mg&#47;kg&#47;day<br>100 mg&#47;kg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Lisinopril<br>15 mg&#47;kg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No significant change in the antihypertensive effect of lisinopril&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Absence of structural abnormalities in cardiac and renal tissues of normotensive rats treated with lisinopril&#43;aspirin or lisinopril alone<br>Degenerative changes in hypertensive rats treated with aspirin&#43;lisinopril &#40;observed even with lower aspirin dose&#41;<br>Significant &#8593; in mortality in hypertensive rats treated with lisinopril&#43;high-dose aspirin &#40;vs&#46; lisinopril alone&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sousa et al&#46;<a class="elsevierStyleCrossRefs" href="#bib0745"><span class="elsevierStyleSup">62&#44;64</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32 male SHR<br>32 male WKY&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 SHR &#40;8 with aspirin&#59; 8 with aspirin&#43;losartan&#41;<br>16 WKY &#40;8 with aspirin&#59; 8 with aspirin&#43;losartan&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 mg&#47;kg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Losartan<br>15 mg&#47;kg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No significant change in the antihypertensive effect of losartan in WKY rats<br>In SHR&#44; &#8593; in antihypertensive effect of losartan with aspirin<br>&#40;SBP&#58;SHR&#43;aspirin&#43;losartan&#58; 174&#46;5&#177;0&#46;9 mmHg&#59; SHR&#43;losartan&#58; 186&#46;3&#177;1&#46;4 mmHg&#44; p&#60;0&#46;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Significant &#8595; of renal COX-2 expression and vasoconstrictive eicosanoids in SHR&#43;aspirin&#43;losartan &#40;vs&#46; SHR&#43;losartan&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">&#8593;&#58; increase&#91;d&#93;&#59; &#8595;&#58; decrease&#91;d&#93;&#59; ABPM&#58; ambulatory blood pressure measurement&#59; ACEIs&#58; angiotensin-converting enzyme inhibitors&#59; ARBs&#58; angiotensin receptor blockers&#59; BBs&#58; beta-blockers&#59; BP&#58; blood pressure&#59; CV&#58; cardiovascular&#59; DBP&#58; diastolic blood pressure&#59; HOT&#58; Hypertension Optimal Treatment&#59; LIFE&#58; Losartan Intervention For Endpoint reduction in hypertension&#59; MAP&#58; mean arterial pressure&#59; PGI<span class="elsevierStyleInf">2</span>&#58; prostacyclin&#59; PRA&#58; plasma renin activity&#59; PPP&#58; Primary Prevention Project&#59; SBP&#58; systolic blood pressure&#59; SD&#58; standard deviation&#59; SEM&#58; standard error of the mean&#59; TXB<span class="elsevierStyleInf">2</span>&#58; thromboxane B<span class="elsevierStyleInf">2</span>&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Study design&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No&#46; of patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No&#46; of patients taking aspirin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Age &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Aspirin dose&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Duration of aspirin treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Antihypertensive treatment&#47;dose&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Effect of combined aspirin treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Other effects&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Smith et al&#46;<a class="elsevierStyleCrossRef" href="#bib0840"><span class="elsevierStyleSup">81</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Double-blind&#44; randomized&#44; crossover study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">53&#46;3&#177;10&#46;6 &#40;mean &#177; SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">75 mg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Captopril 25 mg every 12 hours&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No significant change in MAP &#40;office BP&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Treatment with captopril&#43;aspirin &#8595; serum &#40;but not urinary&#41; TXB<span class="elsevierStyleInf">2</span><br>No significant linear correlation of serum TXB<span class="elsevierStyleInf">2</span> with MAP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Magagna et al&#46;<a class="elsevierStyleCrossRef" href="#bib0810"><span class="elsevierStyleSup">75</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Randomized&#44; placebo controlled&#44; double-blind&#44; two-period crossover trial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30<br>&#40;20 treated hypertensive patients&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">45&#46;7&#177;4&#46;5 &#40;total&#44; mean &#177; SEM&#41;<br>41&#46;5&#177;3&#46;9 &#40;atenolol group&#41;<br>47&#46;8&#177;5&#46;0 &#40;captopril group&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100 mg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Atenolol 100 mg&#47;day<br>Captopril 50 mg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No significant change in office BP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aspirin significantly &#8595; serum and urinary TXB<span class="elsevierStyleInf">2</span> in captopril- and atenolol-treated patients &#40;vs&#46; baseline and placebo&#41;<br>Aspirin significantly &#8595; PRA in captopril- but not in atenolol-treated patients<br>Aspirin slightly &#40;though not significantly&#41; &#8595; urinary 6-keto-PGF1&#945; &#40;PGI<span class="elsevierStyleInf">2</span> metabolite&#41; values in both captopril and atenolol groups&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pol&#243;nia et al&#46;<a class="elsevierStyleCrossRef" href="#bib0845"><span class="elsevierStyleSup">82</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Randomized crossover study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">52&#46;6&#177;1&#46;9 &#40;mean &#177; SEM&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100 mg&#47;day<br>Taken in the morning&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nifedipine &#40;30 mg&#41; or enalapril &#40;20 mg&#41;&#47;day for 4 weeks &#40;in responders to antihypertensive therapy&#41;<br>Nifedipine &#40;60 mg&#41; or enalapril &#40;40 mg&#41; for 4 weeks &#40;in non-responders at the 4th week of the 1st treatment period&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No effect on office BP in nifedipine- or enalapril-treated patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Guazzi et al&#46;<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">10</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Randomized&#44; placebo-controlled&#44; crossover study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">52<br>&#40;26 with mild hypertension&#44; 26 with severe hypertension&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">54&#177;8<br>&#40;mean &#177; SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100 mg&#47;day<br>or<br>300 mg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Enalapril 20 mg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aspirin 100 mg had no effect on office BP&#44; either alone or in combination with enalapril<br>Aspirin 300 mg &#8595; the efficacy of enalapril by 63&#37; in mild hypertensives and by 91&#37; in severe hypertensives&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">In aspirin 300 mg responders &#40;i&#46;e&#46; with more than 20&#37; attenuation of enalapril&#39;s antihypertensive effect&#41;&#44; the enalapril-induced rise in PRA was significantly inhibited&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hansson et al&#46;<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">4</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospective&#44; randomized&#44; open with blinded endpoint evaluation &#40;PROBE&#41; design<br>&#40;HOT randomized trial&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18<span class="elsevierStyleHsp" style=""></span>790<br>&#40;491 lost to follow-up&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9399<br>&#40;245 lost to follow-up in aspirin group&#41;<br>&#40;246 of 9391 patients assigned to placebo group lost to follow-up&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">61&#46;5 &#40;mean&#41; for those remaining in the study<br>61&#46;3 &#40;mean&#41; for those lost to follow-up&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">75 mg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;8 years &#40;mean&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Step 1&#58; Felodipine 5 mg&#47;day given to all patients<br>&#40;additional therapy and dose increments in further steps to reach the randomized target BP&#41;<br>Step 2&#58; ACEI or BB added<br>Step 3&#58; felodipine 10 mg once a day<br>Step 4&#58; doubling the dose of either the ACEI or the BB<br>Step 5&#58; diuretic added&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No differences in achieved BP &#40;office BP&#41; in patients randomized to aspirin or placebo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Association of aspirin with antihypertensive treatment &#8595; the risk of acute myocardial infarction without raising the risk of cerebral bleeding&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nawarskas et al&#46;<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">14</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Double-blind&#44; placebo-controlled&#44; partial crossover&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">44&#177;8&#46;9<br>&#40;enalapril group&#44; n&#61;7&#44; mean &#177; SD&#41;<br>47&#177;13&#46;2 &#40;losartan group&#44; n&#61;10&#44; mean &#177; SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">81 mg&#47;day<br>or<br>325 mg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Enalapril &#8805;5 mg&#47;day<br>Losartan &#8805;25 mg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No significant change in MAP&#44; SBP or DBP &#40;office BP&#41; for both aspirin doses in both enalapril and losartan groups&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8595; serum TXB<span class="elsevierStyleInf">2</span> in both enalapril and losartan groups treated with aspirin<br>Complete suppression of TXB<span class="elsevierStyleInf">2</span> in response to aspirin 325 mg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Avanzini et al&#46;<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">13</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Randomized&#44; controlled&#44; open&#44; 2&#215;2 factorial trial<br>&#40;conducted in the framework of the PPP&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">142&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">59&#46;0&#177;6&#46;0 &#40;total&#44; mean &#177; SD&#41;<br>58&#46;9&#177;6&#46;4 &#40;aspirin&#41;<br>59&#46;2&#177;5&#46;6 &#40;control&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100 mg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ACEIs &#40;51&#46;1&#37; of patients&#41;<br>Calcium antagonists &#40;48&#46;2&#37;&#41;<br>BBs &#40;29&#46;8&#37;&#41;<br>Diuretics &#40;18&#46;4&#37;&#41;<br>Alpha-blockers &#40;14&#46;2&#37;&#41;<br>ARBs &#40;6&#46;4&#37;&#41;<br>Centrally acting agents &#40;3&#46;5&#37;&#41;<br>Drugs and dose not specified&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No change in office BP or in 24-hour BP &#40;on ABPM&#41; compared to baseline<br>Similar BP pattern in control group&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fisman et al&#46;<a class="elsevierStyleCrossRef" href="#bib0850"><span class="elsevierStyleSup">83</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Self-matched control study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31 non-smoking hypertensive or post-infarction patients with ACEI- induced cough&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">61&#177;0&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100 mg&#47;day followed by 500 mg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 week<br>&#40;100 mg&#47;day&#41;<br>&#43;1 week<br>&#40;500 mg&#47;day&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ACEIs<br>Drug and dose not specified&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aspirin did not influence BP control in hypertensives or in post-infarction patients&#44; regardless of dose&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aspirin 100 mg had no effect on ACEI-induced cough<br>Aspirin 500 mg markedly &#8595; ACEI-induced cough in the majority of patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Zanchetti et al&#46;<a class="elsevierStyleCrossRef" href="#bib0860"><span class="elsevierStyleSup">85</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Post-hoc subgroup analysis of HOT trial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18&#160;790<br>&#40;491 lost to follow-up&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9399<br>&#40;245 lost to follow-up in aspirin group&#41;<br>&#40;246 of 9391 patients assigned to placebo group lost to follow-up&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">61&#46;5 &#40;mean&#41; for those remaining in the study<br>61&#46;3 &#40;mean&#41; for those lost to follow-up&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">75 mg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;8 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Step 1&#58; Felodipine 5 mg&#47;day given to all patients<br>&#40;additional therapy and dose increments in further steps to reach the randomized target BP&#41;<br>Step 2&#58; ACEI or BB added<br>Step 3&#58; felodipine 10 mg once a day<br>Step 4&#58; doubling the dose of either the ACEI or the BB<br>Step 5&#58; diuretic added&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">The SBP and DBP &#40;office BP&#41; values achieved&#44; the intensity of the antihypertensive regimen&#44; and the number and type of drug used were similar in aspirin and placebo patients&#44; not only in the overall HOT Study population&#44; but in all subgroups&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fossum et al&#46;<a class="elsevierStyleCrossRef" href="#bib0510"><span class="elsevierStyleSup">15</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Subgroup post-hoc analysis of LIFE study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9193&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1970 with aspirin at baseline &#40;1004 in the losartan group&#59; 966 in the atenolol group&#41; &#40;7223 without aspirin&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">68&#46;4&#177;6&#46;7 &#40;mean &#177; SD&#44; aspirin at baseline&#41;<br>66&#46;6&#177;7&#46;0 &#40;mean &#177; SD&#44; without aspirin at baseline&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aspirin dose not specified &#40;probably low-dose used for prevention of CV events&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;7 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Losartan 50 mg or 100 mg with or without additional antihypertensive drugs<br>Atenolol 50 mg or 100 mg with or without additional drugs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Office BP was similarly &#8595; in aspirin&#43;losartan or aspirin&#43;atenolol patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Greater &#8595; in CV death&#44; stroke&#44; and myocardial infarction with losartan-based compared to atenolol-based treatment in patients using aspirin &#40;vs&#46; patients not using aspirin at baseline&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Prikryl et al&#46;<a class="elsevierStyleCrossRef" href="#bib0855"><span class="elsevierStyleSup">84</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Crossover&#44; double-blind&#44; randomized trial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">46&#46;7&#177;8&#46;6 &#40;mean &#177; SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100 mg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 days&#44; each day at a different circadian stage &#40;on awakening&#44; i&#46;e&#46;&#44; 06&#58;00&#44; and 3&#44; 6&#44; 9&#44; 12&#44; 15&#44; and 18 hours after awakening&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Telmisartan 80 mg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Addition of aspirin to telmisartan further &#8595; circadian amplitude of SBP and DBP &#40;office BP&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Addition of aspirin to telmisartan further &#8595; heart rate amplitude and intrarenal resistive index&#59; it also caused a slight &#8593; in ejection fraction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Leinonen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0545"><span class="elsevierStyleSup">22</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Observational&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">905&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">246&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">65&#46;5&#177;10&#46;9 &#40;total&#44; mean &#177; SD&#41;<br>69&#46;4&#177;9&#46;4 &#40;aspirin group&#41;<br>64&#46;1&#177;11&#46;1 &#40;no aspirin group&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50-250 mg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aspirin given either on the day of measurement or at least 3 times during the preceding week&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Antihypertensive monotherapy &#40;41&#37; aspirin vs&#46; 47&#46;5&#37; no aspirin&#41;&#58;<br>- ACEIs &#40;9&#46;8&#37; vs&#46; 14&#46;6&#37;&#41;<br>- ARBs &#40;1&#46;6&#37; vs&#46; 4&#46;2&#37;&#41;<br>- BBs &#40;15&#46;4&#37; vs&#46; 12&#46;0&#37;&#41;<br>- Calcium antagonists &#40;8&#46;1&#37; vs&#46; 9&#46;1&#37;&#41;<br>- Central acting drugs &#40;0&#37; vs&#46; 0&#46;3&#37;&#41;<br>- Diuretics &#40;6&#46;1&#37; vs&#46; 7&#46;3&#37;&#41;<br>- Combination therapy &#40;58&#46;9&#37; vs&#46; 52&#46;6&#37;&#41;<br>Drugs and dose not specified&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aspirin-treated patients had &#8595; DBP and MAP &#40;office BP&#41;<br>Aspirin &#8595; DBP regardless of whether patients were on antihypertensive monotherapy or combination therapy<br>In univariate linear regression&#44; the use of aspirin was associated with &#8595; DBP and MAP<br>In stepwise multiple linear regression&#44; the use of aspirin remained a significant independent predictor of &#8595; DBP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dimitrov et al&#46;<a class="elsevierStyleCrossRef" href="#bib0865"><span class="elsevierStyleSup">86</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Randomized&#44; open-label&#44; crossover trial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">75 with long-standing hypertension<br>&#40;12&#177;10 years of hypertension&#44; mean &#177; SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">65&#177;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">75 mg&#47;day &#40;64&#37; of patients&#41;<br>80-160 mg&#47;day<br>&#40;33&#37; of patients&#41;<br>300 mg&#47;day<br>&#40;3&#37; of patients&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">One group &#40;n&#61;39&#41; taking aspirin for 1 month in the evening&#44; followed by 1 month in the morning<br>Another group &#40;n&#61;36&#41; taking aspirin for 1 month in the morning&#44; then 1 month in the evening&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">One antihypertensive drug - 13 patients<br>Two drugs - 17<br>patients<br>Three drugs - 26 patients<br>Four drugs - 12 patients<br>Five drugs - 6 patients<br>Six drugs - 1 patient<br>Drugs and doses not specified&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">The time of aspirin administration did not significantly modify 24-hour SBP or 24-hour DBP&#44; or diurnal or nocturnal SBP and DBP &#40;ABPM&#41; values&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bonten et al&#46;<a class="elsevierStyleCrossRef" href="#bib0870"><span class="elsevierStyleSup">87</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospective&#44; randomized&#44; open-label&#44; blinded endpoint &#40;PROBE&#41;&#44; 2-period crossover study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">290 with CV disease &#40;263 in the final analysis&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">290 &#40;263 in the final analysis&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">64&#177;7<br>&#40;mean &#177; SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100 mg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">One group &#40;n&#61;134&#41; taking aspirin on awakening for 3 months&#44; followed by aspirin at bedtime for the same period<br>Another group &#40;n&#61;129&#41; taking aspirin at bedtime for 3 months&#44; followed by aspirin on awakening for the same period&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">BBs &#40;51&#37; in the awakening-bedtime group vs&#46; 55&#37; in the bedtime-awakening group&#41;<br>ACEIs &#40;41&#37; vs&#46; 38&#37;&#41;<br>ARBs &#40;26&#37; vs&#46; 23&#37;&#41;<br>Calcium antagonists &#40;20&#37; vs&#46; 19&#37;&#41;<br>Diuretics &#40;26&#37; vs&#46; 32&#37;&#41;<br>Drugs and doses not specified&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aspirin intake at bedtime did not &#8595; BP compared with intake on awakening&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bedtime aspirin significantly &#8595; morning platelet reactivity compared to aspirin on awakening&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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Informação do artigo
ISSN: 08702551
Idioma original: Inglês
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2020 Dezembro 180 20 200
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2020 Setembro 198 21 219
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2018 Maro 139 18 157
2018 Fevereiro 35 6 41
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2017 Dezembro 66 12 78
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