New York, July 5, 2000 (Praxis Press) Aspirin's antithrombotic effects have made it part of the first-line therapy in the primary prevention of coronary artery disease (CAD), and self-medication is widespread. The potential risk of serious bleeding, however, requires selective prescription. In a recent randomized-controlled trial, Meade et al determined that low-dose aspirin therapy of 75 mg daily did not significantly affect the risk of CAD in patients with higher blood pressure (over 145 mm Hg) while still exposing them to the risks of occasionally serious non-cerebral bleeding (see paper). Low-dose aspirin therapy did reduce the risks of CAD in patients with lower blood pressure (below 130 mm Hg), but the study questions whether these benefits outweigh the increased risk of occasionally serious non-cerebral bleeding. Further studies are needed to determine more precisely at what level of blood pressure aspirin therapy becomes inadvisable. These findings emphasize the importance of blood pressure control prior to the prophylactic use of aspirin.