Hypertension During Pregnancy Risks Long-Term Cardiovascular Outcomes

Research presented at the American Heart Association 2025 Scientific Sessions in New Orleans, Louisiana, demonstrates incremental risks for long-term cardiovascular outcomes and death associated with worsening severity of hypertensive disorders of pregnancy (HDP).¹

The retrospective analysis revealed that a 5-year risk of incident stroke, heart failure, coronary artery disease (CAD), and death increased with worsening HDP severity. It highlights the need for enhanced awareness and aggressive cardiovascular risk reduction strategies in patients with HDP.¹

What Are Hypertensive Disorders of Pregnancy?

Hypertension is one of the most common problems encountered during pregnancy. HDP are classified into 4 categories: chronic hypertension, preeclampsia-eclampsia, preeclampsia (preE) superimposed on chronic hypertension, and gestational hypertension. Pregnant women with HDP typically deliver healthy babies without serious complications in the short- or long-term. Despite the positive outlook, HDP can still be worrisome for both the mother and fetus.²

Effects of high blood pressure range in severity. It can harm the mother’s kidneys and other organs throughout the body, lead to an early delivery, and cause low birth weight. If preeclampsia develops, the lives of both the mother and fetus can be threatened.²

Beyond these serious short-term concerns, HDP can heighten the risk of long-term cardiovascular complications. Research shows that HDP are associated with speedier cardiovascular aging and a range of diverse cardiovascular conditions, including valvular heart disease. Furthermore, HDP is associated with a greater incidence of CAD, aortic stenosis, and mitral regurgitation, especially in middle-aged women.^2,3

Does the Severity of HDP Confer Greater Cardiovascular Risk?

Although the downstream risk of cardiovascular disease due to HDP is affirmed, whether different severities of HDP are associated with long-term differences in cardiovascular risk has yet to be elucidated. In the current study, investigators from Intermountain Health assessed these differences among normotensive postpartum females with varying levels of HDP severity, including gestational hypertension, preE with and without severe features (preE-Sev), and eclampsia.¹

In total, 157,606 unique females from 2017 to 2024 were studied across 22 Intermountain Health hospitals. Preexisting chronic hypertension (cHTN) and HDP conditions were identified by International Classification of Diseases-10 codes and electronic medical records. The index date was defined as the first live delivery for the normotensive group and the first live delivery with HDP for the HDP group. Cox hazard regression analysis examined the association of patient groups and a series of cardiovascular outcomes.¹

Among the cohort, 19.7% (n = 31,077) of patients had HDP, with the majority diagnosed at the first live birth (range: 85%-92%). The average age of the population was 28.9 years, and most patients were White (86.9%).¹

Examination of health records found that patients with HDP had more risk factors compared with normotensive patients, including greater body mass index, smoking, diabetes, hyperlipidemia, depression, and lower socioeconomic status.¹

HDP was associated with a series of adverse outcomes. The presence of HDP conferred a greater follow-up cardiovascular risk, especially for incident stroke, heart failure, CAD, and death. The risk increased according to worsening HDP severity, with cHTN with superimposed HDP and eclampsia being the most severe presentations.¹

“Any form of hypertension during pregnancy significantly increases cardiovascular risk and the risk of death,” Kismet Rasmusson, NP, principal investigator of the trial, said in a news release from Intermountain Health. “This risk is present in women with chronic hypertension prior to pregnancy, and it’s even more pronounced when compounded by severe forms of HDP, such as eclampsia.”⁴

Pharmacists are integral in multidisciplinary care for at-risk women, especially because many pregnant women are unaware of the long-term cardiovascular risks associated with HDP. Frequent follow-up visits and comprehensive clinical care are essential aspects of preventing adverse outcomes due to HDP.^1,4

“We need to do a better job identifying women with these risk factors and ensuring they receive appropriate care before, during, and after pregnancy,” Rasmusson continued. “This is especially critical for those with severe forms of HDP.”⁴

REFERENCES

1. Rasmusson KD, May HT, Hesterberg K, et al. Long-term cardiovascular risks based on stratification by severity of hypertension disorders of pregnancy disease. Presented: American Heart Association 2025 Scientific Sessions; New Orleans, LA; November 9, 2025. Accessed on American Heart Association’s Virtual Platform on November 12, 2025.

2. Mammaro A, Carrara S, Cavaliere A, et al. Hypertensive disorders of pregnancy. J Prenat Med. 2009;3(1):1-5. PMCID: PMC3279097. Accessed November 12, 2025. https://pmc.ncbi.nlm.nih.gov/articles/PMC3279097/

3. Honigberg MC, Zekavat SM, Aragam K, et al. Long-term cardiovascular risk in women with hypertension during pregnancy. J Am Coll Cardiol. 2019;74(22):2743-2754. doi:10.1016/j.jacc.2019.09.052

4. Any form of hypertension during pregnancy significantly increases postpartum cardiovascular risk including death, Intermountain study finds. News release. Intermountain Health. Released November 9, 2025. Accessed November 12, 2025. https://news.intermountainhealth.org/any-form-of-hypertension-during-pregnancy-significantly-increases-postpartum-cardiovascular-risk-including-death-intermountain-study-finds/#:~:text=A%20new%20study%20from%20researchers,five%20years%20of%20giving%20birth.