Of all Hypertensive Disorders of Pregnancy superimposed preeclampsia linked to higher Long-Term CV Risk: JAMA

A new study published in the Journal of the American Medical Association showed that the majority of hypertensive disorders of pregnancy (HDPs) have been associated with slight increases in long-term cardiovascular risk.

Although there is evidence linking hypertensive disorders of pregnancy to a higher long-term risk of cardiovascular disease, it is unclear how much of a risk each HDP subtype carries, especially those other than preeclampsia. Thus, this study investigated if the distribution and risk of particular cardiovascular events vary among HDP subtypes.

This national cohort research used the National Health Insurance Service database to retrospectively examine women who gave birth in South Korea from 2010 to 2018. Chronic hypertension, prenatal hypertension, superimposed preeclampsia, preeclampsia/eclampsia, and nonspecific hypertension were the five subtypes of HDPs.

Up until December 2022, events were confirmed. Analysis of the data took place between June 1 and October 31, 2025. A composite of cardiovascular events, including as heart failure (HF), myocardial infarction (MI), stroke, atrial fibrillation (AF), and cardiovascular mortality, was the main outcome. Cox models were used to estimate adjusted hazard ratios (AHRs), taking into consideration variables related to pregnancy, age, cardiovascular comorbidities, demographics, and lifestyle.

22 876 (4.0%) of the 570 843 women (mean [SD] age, 32.7 [4.0] years) had HDPs. When compared to women without HDPs, those with HDPs had a greater incidence of cardiovascular events (AHR, 1.62; 95% CI, 1.49-1.76; P <.001). Over a median follow-up of 6.5 years, the absolute risk increase was almost 2.10 more cardiovascular events per 1000 person-years (IQR, 4.7-8.7 years; incidence rate, 4.39 vs. 2.29 per 1000 person-years).

Of individuals with HDPs, 2.8% had superimposed preeclampsia, 17.7% had nonspecific hypertension, 12.3% had chronic hypertension, 34.8% had gestational hypertension, and 32.4% had either preeclampsia or eclampsia. When compared to women without HDPs, superimposed preeclampsia showed the greatest risk (AHR, 2.93; 95% CI, 2.15-3.99; P<.001).

All subtypes were independently linked to increased cardiovascular risk. The majority of subtypes were linked to greater cardiovascular mortality, and all subtypes were linked to increased risks of heart failure and stroke. Myocardial infarction was linked to nonspecific hypertension, whereas atrial fibrillation was linked to both chronic and unexplained hypertension.

Overall, the largest risk was found in superimposed preeclampsia, and all HDP subtypes were independently linked to elevated long-term cardiovascular risk. All subtypes had increased risks of HF and stroke, although each subtype had different relationships with MI and AF.

Source:

Kwak, S., Park, C. S., Park, Y., Rhee, T.-M., Lee, H., Kim, H.-K., Kim, Y.-J., Han, K., & Park, J.-B. (2026). Hypertensive disorders of pregnancy subtypes and long-term cardiovascular risk. JAMA Internal Medicine. https://doi.org/10.1001/jamainternmed.2025.7802