Nadeem Abdullah, Rais Taruba, Aamir Minahil, Habte Alexander, Siddiqui Tasmiyah, Karamat Riyan Imtiaz, Munsab Rabbia, Habib Ashna
Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan.
Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.
Front Cardiovasc Med. 2024 Oct 22;11:1346265. doi: 10.3389/fcvm.2024.1346265. eCollection 2024.
Cardiovascular disease (CVD) is a leading global cause of morbidity and mortality, with high systolic blood pressure (SBP) identified as a major risk factor. Aspirin (Acetylsalicylic acid-ASA) has been considered for CVD prevention, prompting questions about its optimal use in primary and secondary prevention and the ideal dosing time to maximize its impact on circadian blood pressure rhythms. Previous research suggests a potential benefit of bedtime aspirin dosing in reducing blood pressure, attributed to its effects on the renin-angiotensin-aldosterone system and nitric oxide production. This systematic review and meta-analysis aim to further explore the circadian effects of aspirin on blood pressure, focusing on the timing of administration.
Adhering to PRISMA guidelines, a comprehensive search of PubMed, Cochrane Library, and clinicaltrials.gov was conducted. Randomized controlled trials (RCTs) involving patients aged >18 with cardiovascular history and hypertension were included. The primary objective was to assess the impact of bedtime-dosed and morning-dosed aspirin on systolic and diastolic blood pressure. Low-dose aspirin was administered for primary or secondary prevention. The Cochrane Risk of Bias tool evaluated study quality. Meta-analyses were conducted using RevMan 5.3, with mean deviations and 95% confidence intervals employed for outcomes.
Initial searches yielded 1,181 articles, with six studies meeting the inclusion criteria. These RCTs involved 1,470 patients, with 1,086 completing follow-up. Bedtime aspirin dosing demonstrated a significant reduction in both systolic and diastolic blood pressure compared to morning dosing ( < 0.05). Meta-analysis results for systolic blood pressure revealed a weighted mean difference of approximately 3.65 mmHg in favour of bedtime dosing, with low heterogeneity ( = 0%). For diastolic blood pressure, the weighted mean difference was 1.92, again favouring bedtime dosing, with 3% heterogeneity.
This meta-analysis, involving over 1,300 cardiovascular/hypertensive patients, supports the effectiveness of bedtime aspirin in reducing systolic and diastolic blood pressure compared to morning dosing. The results align with previous findings but distinguish themselves by incorporating a more diverse patient population and addressing moderate heterogeneity. While the study's outcomes are promising, further research, including larger sample sizes and longer durations, is warranted for comprehensive clinical implementation. As the study exclusively focused on aspirin timing, future investigations should explore sustained blood pressure effects in patients with clinical indications for aspirin alongside other hypertensive medications.
心血管疾病（CVD）是全球发病和死亡的主要原因，高收缩压（SBP）被确定为主要危险因素。阿司匹林（乙酰水杨酸 - ASA）已被考虑用于预防心血管疾病，这引发了关于其在一级和二级预防中的最佳使用以及使对昼夜血压节律影响最大化的理想给药时间的问题。先前的研究表明睡前服用阿司匹林在降低血压方面具有潜在益处，这归因于其对肾素 - 血管紧张素 - 醛固酮系统和一氧化氮生成的作用。本系统评价和荟萃分析旨在进一步探讨阿司匹林对血压的昼夜影响，重点关注给药时间。
遵循PRISMA指南，对PubMed、Cochrane图书馆和clinicaltrials.gov进行了全面检索。纳入了涉及年龄大于18岁且有心血管病史和高血压的患者的随机对照试验（RCT）。主要目的是评估睡前给药和早晨给药的阿司匹林对收缩压和舒张压的影响。低剂量阿司匹林用于一级或二级预防。使用Cochrane偏倚风险工具评估研究质量。使用RevMan 5.3进行荟萃分析，结果采用平均偏差和95%置信区间。
初步检索得到1181篇文章，六项研究符合纳入标准。这些RCT涉及1470名患者，其中1086名完成随访。与早晨给药相比，睡前服用阿司匹林在收缩压和舒张压方面均有显著降低（<0.05）。收缩压的荟萃分析结果显示，加权平均差约为3.65 mmHg，支持睡前给药，异质性低（I² = 0%）。对于舒张压，加权平均差为1.92，同样支持睡前给药，异质性为3%。
这项涉及1300多名心血管/高血压患者的荟萃分析支持与早晨给药相比，睡前服用阿司匹林在降低收缩压和舒张压方面的有效性。结果与先前的研究结果一致，但通过纳入更多样化的患者群体和解决中度异质性而有所不同。虽然该研究的结果很有前景，但为了全面的临床应用，仍需要进一步的研究，包括更大的样本量和更长的持续时间。由于该研究仅关注阿司匹林的给药时间，未来的研究应探索在有阿司匹林临床适应症的患者中与其他降压药物一起使用时血压的持续影响。
