| Objective The purpose of this study was to evaluate the benefits and possible risks of hypertensive patients using aspirin for primary prevention of cardiovascular disease.Through a meta-analysis of relevant studies on the use of aspirin in the primary prevention of cardiovascular disease in hypertensive patients,provide guidance for the clinical use value of aspirin in the primary prevention of cardiovascular disease in hypertensive patients and the population that may benefit.Methods A computer network was used to retrieve related research on primary prevention of cardiovascular disease in patients with hypertension from Pub Med,Wed of Science,Cochrane Library,Weipu database,CNKI,Wanfang database and Chinese biomedical database.Formulate literature retrieval strategies based on PICO principles: research subjects(P),interventions(I),comparative measures(C),and outcomes(O).The study subjects were hypertensive patients who had not yet developed cardiovascular disease or were still in preclinical stage;the intervention was oral aspirin;the control measure was oral placebo,and the outcome was the occurrence of cardiovascular disease in patients with hypertension.The database was built until September 2019.And according to the established literature inclusion and exclusion criteria for literature screening(Inclusion criteria:(1)The study was designed as a randomized controlled trial of oral aspirin for primary prevention of cardiovascular disease in hypertensive patients;(2)The experimental group was oral aspirin and the control group was oral placebo;(3)Outcome indicators: effectiveness and safety outcome indicators;Exclusion criteria:(1)review,case reports,etc.;(2)repeated studies;(3)animal studies).Finally,13 eligible studies were included,and the included literature was evaluated using the Jadad quality score scale.Of the 13 studies included,11 were high-quality studies and the remaining 2 were low-quality studies.Two researchers independently carried out the literature inclusion work and extracted the literature data according to the established literature inclusion and exclusion criteria.The funnel chart and Begg rank correlation test were used to evaluate the publication bias of the included documents.Meta-analysis was performed using STATA 12.0 software.Results Aspirin can reduce the risk of various cardiovascular disease in primary prevention of cardiovascular disease in patients with hypertension(RR,0.93;95% CI: 0.90-0.96;P <0.001).However,while aspirin reduces the risk of cardiovascular disease,it also increases the incidence of adverse reactions such as major bleeding and minor discomfort(RR,1.28;95% CI:1.19-1.39;P<0.05).Subgroup analysis shows that as primary prevention aspirin mainly reduces the risk of non-fatal cardiovascular disease than placebo(RR,0.94;95%CI: 0.90-0.98;P<0.05);however,the efficacy of primary prevention of fatal cardiovascular disease is not clear,failing to significantly reduce the risk of fatal cardiovascular events(RR,0.95;95%CI: 0.89-1.00;P>0.05).Besides,oral aspirin group not only increased minor discomfort(RR,1.29;95% CI:1.19-1.41;P<0.05)but also bleeding risk compared to placebo group(RR,1.22;95% CI: 1.03-1.45;P=0.022).In order to rule out that high-dose aspirin may increase the risk of major bleeding,two studies of oral high-dose aspirin were removed and analyzed,and it was found that even low-dose aspirin still significantly increased the risk of bleeding(RR,1.24,95%CI: 1.03-1.49,P=0.022).Conclusion Aspirin for primary prevention of cardiovascular disease in patients with hypertension can indeed reduce the risk of non-fatal cardiovascular disease,while the effect for fatal cardiovascular disease is uncertain.Aspirin can induce bleeding risk while playing this role.Therefore,whether patients with hypertension can use aspirin for primary prevention of cardiovascular disease needs to fully assess the benefits and risks;how to identify the people who can really benefit from it,it is necessary to strictly grasp the indications for use. |
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