FOCUS ISSUE: ASPIRIN: VIEWPOINT
Aspirin Administered at Bedtime, But Not on Awakening, Has an Effect on Ambulatory Blood Pressure in Hypertensive Patients
Ramón C. Hermida, PhD*,*,
Diana E. Ayala, MD, PhD*,
Carlos Calvo, MD, PhD and
José E. López, MD, PhD
* Department of Bioengineering and Chronobiology Laboratories, University of Vigo, Campus Universitario, Vigo, Spain
Hypertension and Vascular Risk Unit, Hospital Clínico Universitario, Santiago de Compostela, Spain
Manuscript received June 23, 2004;
revised manuscript received August 20, 2004,
accepted August 23, 2004.
* Reprint requests and correspondence: Dr. Ramón C. Hermida, Bioengineering and Chronobiology Labs, E.T.S.I. Telecomunicación, Campus Universitario, Vigo (Pontevedra) 36200, Spain. (Email: rhermida{at}tsc.uvigo.es).
OBJECTIVES: The purpose of this research was to investigate in untreated hypertensive patients the effects on ambulatory blood pressure (BP) of aspirin (ASA) administered at different times of the day.
BACKGROUND: Previous studies have shown that ASA produces an administration time-dependent inhibition of angiotensin II. Low-dose ASA has also been shown to reduce BP when administered before bedtime, as opposed to upon awakening, in normotensive and hypertensive volunteers, and in pregnant women at high risk for preeclampsia.
METHODS: We studied 328 untreated patients with grade 1 hypertension, 44.0 ± 12.6 years of age, randomly divided into three groups: nonpharmacological hygienic-dietary recommendations, the same recommendations and ASA (100 mg/day) on awakening, or the same recommendations and ASA before bedtime. Blood pressure was measured every 20 min during the day and every 30 min at night for 48 consecutive h before and after 3 months of intervention.
RESULTS: After three months of nonpharmacological intervention, there was a small and nonsignificant reduction of BP (<0.2 mm Hg; p = 0.648). Blood pressure was slightly elevated after aspirin on awakening (2.6/1.6 mm Hg in the 24-h mean of systolic/diastolic BP; p = 0.002). A significant BP reduction, however, was observed in the patients who received aspirin before bedtime (6.8/4.6 mm Hg in systolic/diastolic BP; p < 0.001).
CONCLUSIONS: This prospective trial documents a significant administration time-dependent effect of low-dose ASA on BP in untreated hypertensive patients. The timed administration of low-dose ASA could provide a valuable approach, beyond the secondary prevention of cardiovascular disease, in the added BP control of patients with mild essential hypertension.
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Abbreviations and Acronyms
| | ABPM = ambulatory blood pressure monitoring | | ASA = aspirin | | BMI = body mass index | | BP = blood pressure | | COX = cyclooxygenase | | DBP = diastolic blood pressure | | HDR = hygienic-dietary recommendations | | HR = heart rate | | NSAID = non-steroidal anti-inflammatory drug | | PROBE = prospective, randomized, open-label, blinded end point | | SBP = systolic blood pressure |
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