Health experts have warned against arbitrary use of aspirin in managing high blood pressure.
Responding to an emailed inquiry by this writer, Dr Loise Nyanjau of the Ministry of Health (MoH) said low-dose aspirin increases the risk of brain haemorrhage.
Long regarded as a wonder drug in the management of heart diseases, it is emerging that aspirin has no role in the routine treatment of hypertension.
WebMD defines bleeding in the brain (brain haemorrhage) as a type of stroke and attributes 13 per cent of strokes to such bleeding.
A stroke occurs when an artery in the brain bursts. The resulting bleeding kills the brain cells.
When blood from trauma irritates brain tissues, it causes swelling. This, WebMD says, is known as cerebral oedema.
“The pooled blood collects into a mass called a haematoma. These conditions increase pressure on nearby brain tissue, and that reduces vital blood flow and kills brain cells.”
Bleeding can occur inside the brain, between the brain and the membranes that cover it, between the layers of the brain’s covering or between the skull and the covering of the brain.
Dr Nyanjau, a medical officer at the cardiovascular diseases (CVD) desk in the Non-Communicable Diseases (NCD) Unit of MoH, based her comments on the Kenya National Guidelines for Cardiovascular Diseases Management 2018.
“Aspirin is used to prevent the occurrence of cardiovascular diseases such as heart attack and stroke (that often kill or cause permanent disability) by reducing the chances of a blood clot forming in vulnerable individuals,” Dr Nyanjau said.
She added, however, that not all hypertensives need aspirin, which is best for persons with prior history of cardiovascular disease like a heart attack or stroke.
The rationale here is that the benefit of preventing another heart attack or stroke outweighs the risk of bleeding.
Use of aspirin, Dr Nyanjau said, is considered for persons with very high risk of developing cardiovascular disease depending on the person’s risk of bleeding and following a discussion with their health provider.
Dr Juliet Makanga, a neuropharmacologist and lecturer at Kenyatta University’s School of Pharmacy, shared Dr Nyanjau’s view on discretionary use of aspirin.
“Regardless of its effect on blood pressure, studies have shown that low-dose aspirin effectively prevents cardiovascular events in patients,” she said.
“However, the benefits of aspirin in hypertensive patients in the prevention of cardiovascular events such as myocardial infarction, that is heart attack, must be balanced against the risk of bleeding in the gut and in the brain.”
She advised proper management and medical follow-up. “Low-dose aspirin is not for every patient, and only the physician, having compounded various patient parameters, is best placed to make the decision,” she said.
Kenya Network of Cancer Organisations chairman David Makumi noted that some studies have shown that aspirin also protects against colon cancer.
“However, the long-term side effects like bleeding in the stomach outweigh the decision to use it for colon cancer prevention,” he said.
In spite of the warnings, the reality on the ground is different, with Nairobi chemists dishing out low-dose aspirin over-the-counter without prescription.
CNN first raised the red flag on low-dose aspirin last September 17 when it reported three research findings in the New England Journal of Medicine.
The studies showed that “a daily low-dose aspirin regimen provides no significant health benefits for healthy older adults. Instead, it may cause them serious harm.”
It is “a waste of money for healthy older adults. At worst, it may raise their risk of internal bleeding and early death,” the international TV station said.
Perhaps due to the sensitivity of the subject and the clout of big pharma, the researchers fell short of telling healthy adults to stop routine ingestion of aspirin.
Instead, they said: “Always consult your doctor before starting or stopping any medication” — a tall order in Kenya, where astronomical healthcare costs force patients to choose over-the-counter shortcuts.
Earlier in 2017, Sayer Ji of GreenMedInfo cited a Dutch study published in the journal Heart, which found that, “among 27,939 healthy female health professionals (average age 54) randomised to receive either 100 mg of aspirin every day or a placebo, the risk of gastrointestinal bleeding outweighed the benefit of the intervention for colorectal cancer and cardiovascular disease prevention in those under 65 years of age”.
Heart is a British international peer reviewed journal that keeps cardiologists up to date with important research advances in cardiovascular disease.
While the Kenya Health Policy 2014-2030 seeks to attain the highest possible standard of health in a manner responsive to the population’s health needs, by among other things, halting and reversing the rising burden of NCDs, unregulated use of low-dose aspirin is proving to be counterproductive.