Aspirin is a widely used drug in clinical practice. It is a “double-edged sword” that reduces the risk of adverse cardiovascular and cerebrovascular events (e.g., myocardial infarction, cerebral infarction) but may also increase the risk of bleeding (e.g., severe cerebral or gastrointestinal bleeding, especially in the elderly). Therefore, not all patients with hypertension need to take aspirin. If there is no indication or if there are contraindications or if the disadvantages outweigh the benefits, patients with hypertension taking aspirin may not only not prevent the disease, but also bring adverse consequences. (1) For patients with hypertension who have had coronary heart disease (including myocardial infarction), cerebral infarction, or significant narrowing (more than 50%) of the carotid or lower extremity arteries, they should take aspirin for a long time, but only if they first keep their blood pressure under 150/90 mmHg. Those with poorly controlled blood pressure (especially above 180/110mmHg) are prone to increased risk of cerebral hemorrhage by taking aspirin. (2) Patients with hypertension who do not have coronary heart disease or cerebrovascular disease, but are 50-70 years old, and who also have a combination of risk factors such as diabetes, smoking, hyperlipidemia, obesity, and urinary protein, should also take aspirin, provided that they also have their blood pressure well controlled first. (3) Aspirin is not recommended for hypertensive patients who do not have either of these conditions. The pros and cons of taking aspirin should be weighed for each hypertensive patient’s specific situation (age, risk of cardiovascular disease, liver and kidney function, bleeding risk, benefit ratio, etc.). It is recommended that aspirin be taken under the supervision of a regular hospital cardiologist.