Long-Term Cardiovascular Outcomes After Hypertensive Disorders of Pregnancy

Abstract

Introduction: Hypertensive disorders of pregnancy (HDP) affect 5–10% of pregnancies. Whether they independently increase long-term cardiovascular disease (CVD) risk beyond subsequent hypertension is debated.
Methods: We conducted a systematic review and meta-analysis of cohort studies with ≥5 years postpartum follow-up comparing women with history of HDP (gestational hypertension, preeclampsia) to those with normotensive pregnancies. Primary outcome: composite CVD (MI, stroke, HF, CVD death). Adjusted HRs extracted.
Results: 31 cohort studies (n=3.2 million women) included. Median follow-up 12 years. HDP was associated with adjusted HR 2.1 (95%CI 1.8–2.5) for composite CVD. Risk for ischemic stroke: HR 2.3 (1.9–2.8); for heart failure: HR 2.4 (1.9–3.1). Preeclampsia with preterm delivery conferred highest risk (HR 3.5 vs. term preeclampsia HR 1.8). Risk attenuation after adjusting for postpartum hypertension: HR 1.5 (1.3–1.8), indicating partial mediation.
Discussion: Residual confounding by prepregnancy BMI and metabolic syndrome cannot be fully excluded. Mechanisms may include persistent endothelial dysfunction and accelerated arterial stiffness. Most studies lacked detailed coronary imaging. Universal screening postpartum remains poor.
Conclusions: Women with HDP, especially preterm preeclampsia, have twofold higher long-term CVD risk. Early postpartum cardiovascular risk assessment and lifestyle interventions are warranted. Guidelines should mandate follow-up at 6–12 weeks postpartum.