Can aspirin ointment increase blood pressure?

Does Aspirin Ointment Increase Blood Pressure?

Topical aspirin ointment (like slgesal baum) is unlikely to increase blood pressure when used as directed, as systemic absorption is minimal compared to oral aspirin formulations.

Mechanism and Evidence

Aspirin's potential effects on blood pressure depend on several factors:

1. Route of Administration:

   • Topical applications like ointments result in significantly lower systemic absorption than oral formulations
   • The European Society of Hypertension/European Society of Cardiology guidelines primarily address oral aspirin administration 1

2. Systemic Effects of Oral Aspirin:

   • Low-dose oral aspirin (75-162 mg/day) has been shown to have minimal effects on blood pressure control 1
   • According to the American College of Chest Physicians guidelines, "Low-dose aspirin therapy has not been reported to affect renal function or BP control" 1
   • The Hypertension Optimal Treatment (HOT) trial demonstrated that low-dose aspirin (75 mg/day) did not interfere with blood pressure control in hypertensive patients 2

3. Timing-Dependent Effects:

   • Some research suggests that oral aspirin administration timing may influence blood pressure effects
   • When taken orally at bedtime (rather than upon awakening), aspirin has shown modest blood pressure-lowering effects in some studies 3, 4
   • However, these timing effects are primarily relevant to oral administration, not topical applications

Clinical Considerations

When using topical aspirin products:

• Minimal Systemic Absorption: Topical preparations typically have limited systemic absorption, reducing the risk of systemic effects including blood pressure changes

• Monitoring Recommendations:

  • No special blood pressure monitoring is required specifically for topical aspirin products
  • Regular blood pressure monitoring should continue as normally indicated for patients with hypertension

• Contraindications:

  • Aspirin allergy
  • Open wounds or damaged skin (which could increase absorption)
  • Known sensitivity to salicylates

Special Populations

For patients with specific conditions:

• Hypertension: No evidence suggests that topical aspirin preparations worsen blood pressure control 1

• Patients on Antihypertensive Medications: Research shows that even oral low-dose aspirin does not interfere with the blood pressure-lowering effects of antihypertensive agents, including ACE inhibitors 2

• Renal Disease: While NSAIDs can affect renal function, low-dose aspirin is "a very weak inhibitor of renal prostaglandin synthesis and has no clinically significant effect on renal function or on blood pressure control" 1

In conclusion, while high-dose oral aspirin and other NSAIDs may potentially affect blood pressure, topical aspirin ointment presents minimal risk for increasing blood pressure due to its limited systemic absorption.