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Aspirin is beneficial in hypertensive patients with chronic kidney disease: A post-hoc subgroup analysis of a randomized controlled trial

Jardine, Meg J., Ninomiya, Toshiharu, Perkovic, Vlado, Cass, Alan, Turnbull, Fiona, Gallagher, Martin P., Zoungas, Sophia, Lambers Heerspink, Hiddo J., Chalmers, John and Zanchetti, Alberto (2010). Aspirin is beneficial in hypertensive patients with chronic kidney disease: A post-hoc subgroup analysis of a randomized controlled trial. Journal of the American College of Cardiology,56(12):956-965.

Document type: Journal Article

IRMA ID 84473293xPUB25
Title Aspirin is beneficial in hypertensive patients with chronic kidney disease: A post-hoc subgroup analysis of a randomized controlled trial
Author Jardine, Meg J.
Ninomiya, Toshiharu
Perkovic, Vlado
Cass, Alan
Turnbull, Fiona
Gallagher, Martin P.
Zoungas, Sophia
Lambers Heerspink, Hiddo J.
Chalmers, John
Zanchetti, Alberto
Journal Name Journal of the American College of Cardiology
Publication Date 2010
Volume Number 56
Issue Number 12
ISSN 0735-1097   (check CDU catalogue  open catalogue search in new window)
Scopus ID 2-s2.0-77956525281
Start Page 956
End Page 965
Total Pages 9
Publisher Elsevier
HERDC Category C1 - Journal Article (DIISR)
Abstract Objectives
The purpose of this study was to determine the benefit and risk associated with antiplatelet therapy in the chronic kidney disease (CKD) population.

Background
Cardiovascular and possibly bleeding risks are elevated in patients with CKD. The balance of benefit and harm associated with antiplatelet therapy remains uncertain.

Methods
The HOT (Hypertension Optimal Treatment) study randomly assigned participants with diastolic hypertension to aspirin (75 mg) or placebo. Study treatment effects were calculated using univariate proportional hazards regression models stratified by baseline estimated glomerular filtration rate (eGFR) with trends tested by adding interaction terms. End points included major cardiovascular events, total mortality, and major bleeding.

Results
The study included 18,597 participants treated for 3.8 years. Baseline eGFR was <60 ml/min/1.73 m2 in 3,619 participants. Major cardiovascular events were reduced by 9% (95% confidence interval [CI]: −9% to 24%), 15% (95% CI: −17% to 39%), and 66% (95% CI: 33% to 83%) for patients with baseline eGFR of ≥60, 45 to 59, and <45 ml/min/1.73 m2, respectively (p trend = 0.03). Total mortality was reduced by 0% (95% CI: −20% to 17%), 11% (95% CI: −31% to 40%), and 49% (95% CI: 6% to 73%), respectively (p trend = 0.04). Major bleeding events were nonsignificantly greater with lower eGFR (hazard ratio [HR]: 1.52 [95% CI: 1.11 to 2.08], HR: 1.70 [95% CI: 0.74 to 3.88], and HR: 2.81 [95% CI: 0.92 to 8.84], respectively; p trend = 0.30). Among every 1,000 persons with eGFR <45 ml/min/1.73 m2 treated for 3.8 years, 76 major cardiovascular events and 54 all-cause deaths will be prevented while 27 excess major bleeds will occur.

Conclusions
Aspirin therapy produces greater absolute reduction in major cardiovascular events and mortality in hypertensive patients with CKD than with normal kidney function. An increased risk of major bleeding appears to be outweighed by the substantial benefits.
Keywords aspirin
bleeding
cardiovascular risk
chronic kidney disease
mortality
primary prevention
risk-benefit analysis
DOI http://dx.doi.org/10.1016/j.jacc.2010.02.068   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
 
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