Can aspirin (acetylsalicylic acid) cause hypertension?

From the Guidelines

Aspirin does not typically cause hypertension and may have a slight blood pressure-lowering effect in some individuals. The most recent and highest quality study, published in 2018 in Diabetes Care 1, does not mention aspirin as a cause of hypertension. In fact, the study recommends the use of aspirin therapy (75–162 mg/day) as a secondary prevention strategy in those with diabetes and a history of atherosclerotic cardiovascular disease, without mentioning any concerns about aspirin-induced hypertension.

Key Points to Consider

• Aspirin works differently than other non-steroidal anti-inflammatory drugs (NSAIDs), with less impact on certain prostaglandins that affect kidney function and blood vessel tone, which may contribute to its lack of effect on blood pressure 1.
• The main adverse effect of aspirin is an increased risk of gastrointestinal bleeding, with an excess risk of up to 5 per 1,000 per year in real-world settings 1.
• The decision to use aspirin should be based on the individual's cardiovascular risk profile, with the benefits of aspirin outweighing the risks of bleeding in patients with established cardiovascular disease 1.

Monitoring and Precautions

• If you're concerned about blood pressure effects while taking aspirin, it's advisable to monitor your blood pressure regularly and discuss any significant changes with your healthcare provider.
• This is especially important if you're taking aspirin for heart protection (typically 81-325 mg daily) alongside blood pressure medications, as medication interactions can occur.

From the Research

Aspirin and Hypertension

• The relationship between aspirin (acetylsalicylic acid) and hypertension is complex, with varying effects depending on the dosage, administration time, and patient population 2, 3, 4, 5, 6.
• Some studies suggest that low-dose aspirin does not interfere with the blood pressure-lowering effects of antihypertensive therapy and may even have beneficial effects on cardiovascular events 2, 3.
• However, other studies have found that aspirin can increase blood pressure in certain populations, such as non-dipper hypertensive patients, and may even elevate the risk of hemorrhagic events 4, 5.
• The timing of aspirin administration may also play a role, with bedtime administration potentially reducing blood pressure and awakening administration potentially increasing it 4.
• A review of published data on the effects of aspirin on blood pressure found that the evidence is conflicting, with some trials suggesting a blood pressure-lowering effect and others showing an increase in the risk of hypertension 6.

Key Findings

• Low-dose aspirin does not interfere with the blood pressure-lowering effects of antihypertensive therapy in most patients 2, 3.
• Aspirin may have differing effects on blood pressure depending on the administration time, with bedtime administration potentially being more beneficial 4.
• The risk of hemorrhagic events, such as gastric bleeding and hemorrhagic stroke, should be carefully weighed against the potential benefits of aspirin therapy 5, 6.
• The relationship between aspirin and hypertension is complex and may depend on various factors, including patient population, dosage, and administration time 2, 3, 4, 5, 6.