Should patients with hypertension receive antithrombotic therapy?

The main complications of hypertension, i.e. coronary heart disease, ischae mic strokes and peripheral vascular disease (PVD), are usually related to t hrombosis. Increasing evidence also suggests that hypertension fulfils the components of Virchow's triad, thus conferring a prothrombotic or hypercoag ulable state. as evident by abnormalities of haemostasis, platelets and end othelial function. It therefore seems plausible that use of antithrombotic therapy may help prevent these thrombosis-related complications of hyperten sion. Indeed, hypertensive patients with an estimated 10-year CHD risk greater th an or equal to 15%, will have their cardiovascular risk reduced by 25% usin g antihypertensive treatment, but the addition of aspirin further reduces m ajor cardiovascular events by 15%,. Recent guide lines recommend the use of aspirin 75 mg daily for hypertensive patients who have no contraindication to aspirin, in one of the following categories: ii) secondary prevention - cardiovascular complications (myocardial infarction, angina, non-haemorrha gic stroke, peripheral vascular disease or atherosclerotic renovascular dis ease); and iii) primary prevention - those with blood pressure controlled t o < 150/90 mmHg and one of: (a) age <greater than or equal to> 50 years and target organ damage (e.g. LVH, renal impairment, or proteinuria): (b) a 10 -year CHD risk greater than or equal to 15%; or (c) type II diabetes mellit us. However, some of the risks of aspirin administration, namely increased incidence of major bleeding events, may possibly outweigh the benefits. esp ecially in low-risk individuals.