Low-dose aspirin is often used to prevent superimposed preeclampsia in women with chronic hypertension, but its effectiveness remains limited. Factors such as dosage, timing of therapy initiation, timing of ingestion, and adherence may contribute to this reduced efficacy, yet these aspects are underexplored and yield conflicting results. Understanding the interplay of these factors and the underlying pathogenesis is critical to optimizing aspirin therapy.
This integrative literature review aimed to investigate the reasons for aspirin’s low effectiveness in preventing superimposed preeclampsia in women with chronic hypertension and propose strategies to enhance its efficacy. It also synthesized evidence on the impact of aspirin dosage, gestational timing, ingestion timing, and adherence in this population.
Following the Whittemore and Knafl procedure, we conducted an integrative review of 17 studies sourced from PubMed, Hinari, and Google Scholar. The review included studies evaluating aspirin’s effectiveness in relation to dosage, gestational age at initiation, timing of ingestion, and adherence. Data were extracted, analyzed, and synthesized to identify patterns and propose therapy modifications.
The review revealed that superimposed preeclampsia in chronic hypertension involves multiple pathogenic pathways, with aspirin targeting only one, limiting its effectiveness. Higher aspirin doses (≥150 mg) were found to be safer and more effective in most populations. Optimal outcomes were associated with initiating therapy before 12 weeks of gestation and taking aspirin at night/bedtime with >90% adherence. These factors collectively improved aspirin’s preventive effects, though gaps in efficacy persisted due to unaddressed pathways.
To enhance aspirin’s effectiveness in preventing superimposed preeclampsia in women with chronic hypertension, multi-component pharmacological approaches, such as combining aspirin with L-arginine or S-nitroglutathione, are recommended to target multiple pathogenic pathways. Early identification and control of hypertension, aspirin doses ≥150 mg, initiation before 12 weeks of gestation, and high adherence (>90%) at night/bedtime are critical for optimal outcomes. Further research, consistent patient follow-up, and combined adherence measurement methods are needed to refine these strategies and improve clinical practice.
Source: https://bmccardiovascdisord.biomedcentral.com/articles/10.1186/s12872-025-04941-z
