Clinical evidence of dose-dependent interaction between aspirin and angiotensin-converting enzyme inhibitors

Abstract

Since coronary artery and cerebrovascular diseases are the most common serious complications of long standing hypertension, there is a great potential for combining treatment with aspirin and angiotensin-converting enzyme inhibitors (ACE-I). However, the data regarding interaction of aspirin and ACE-I in relation to blood pressure control and survival benefits are controversial and inconclusive. We presumed that the appearance of dry cough in some of the patients following initiation of ACE-I treatment could be used as a marker for the presence of their influence, whereas ACE-I cough attenuation after addition of aspirin to treatment could be a sign of aspirin and ACE-I interaction on clinical level. The present study was aimed to use ACE-I induced cough as a clinical marker of ACE-I activity to determine whether dose-dependent aspirin and ACE-I interaction does exist. In a cohort of 750 consecutive ACE-I treated hypertensive and postinfarction outpatients we identified 78 (10.4%) non-smoking ACE-I related coughers. Out of them, 31 (21 men, 10 women; mean age 61 ± 0.9 years) agreed to take part in the study, which was aimed to compare two regimens of combined ACE-I and aspirin treatment (self-matched control data): intermediate (500 mg daily) vs low-dose aspirin (100 mg daily). On each visit the life quality, cough severity (CS, 0-4) and frequency (CF, 0-10) scores were registered. Low doses

Aspirin Inhibits the Acute Arterial and Venous Vasodilator Response to Captopril in Patients with Chronic Heart Failure

“…The response to captopril in our study started at around 15 min and continued to 180 min in keeping with the findings of other investigators [3]. There is a general consensus that "high dose" aspirin (>150 mg daily) antagonises the vasodilator and other actions of ACE inhibitors, though not all studies have confirmed this finding [18][19][20]. These discrepancies may be due to the use of different ACE inhibitors [19] and the use of a protocol that examined the effect of a single dose of captopril administered with aspirin rather than pretreatment with aspirin [20].…”

Effects of low-dose aspirin on blood pressure and endothelial function of treated hypertensive hypercholesterolaemic subjects

“…Although positive interaction between aspirin and losartan was shown in one study, 19 other investigators did not find any significant interference of aspirin with the BP-lowering effect of antihypertensive agents, including combinations with ACE inhibitors. [20][21][22][23] It is unlikely that improvement of BP control and endothelial function in our patient was caused by cyclooxygenase (COX) inhibition. Nonselective COX inhibition is associated with antinatriuretic and vasoconstrictor effects.…”

Antihypertensive Effects of Aspirin: What is the Evidence?

“…This hypothesis has been tested in several short trials among patients with essential hypertension (Table 1) [31][32][33][34][35][36][37][38][39][40]. None of these trials has shown a significant difference in the effect of antihypertensive drugs, including ACE inhibitors, in the context of treatment with varying doses of aspirin.…”