New data from JAMA Cardiology indicates that 17.8% of women developed hypertension within 7 years of their first pregnancy, influenced by genetics, BMI, and HDP history.
A cohort study published in JAMA Cardiology found that a higher genetic predisposition for elevated systolic blood pressure (SBP) was independently associated with the development of new-onset hypertension between 2 and 7 years after delivery. Although genetic risk scores emerged as a significant predictor for women without a history of hypertensive disorders of pregnancy (HDP), researchers noted that clinical factors, specifically a history of HDP and elevated body mass index (BMI), remained the most substantial contributors to postpartum hypertension risk.
Cardiovascular disease is the primary cause of mortality in women, and pregnancy often acts as a physiological stress test that can unmask underlying cardiometabolic susceptibilities. Hypertensive disorders of pregnancy, which include gestational hypertension and preeclampsia, have seen a rising incidence in the United States, increasing from 4.4% to 9.4% between 2010 and 2021. Women with a history of HDP face a greater than 3-fold risk of future chronic hypertension, which mediates more than 50% of their long-term cardiovascular risk, according to the study investigators.
The study utilized data from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b) Heart Health Study. The cohort included 2852 genotyped participants without pregestational chronic hypertension who were enrolled during pregnancy between 2010 and 2013 and followed up at 8 clinical sites across the United States. Study data were analyzed from October 2024 to January 2026.
To quantify genetic predisposition, researchers utilized a genome-wide SBP polygenic score, categorizing participants into low (bottom quintile), intermediate (quintiles 2-4), or high (top quintile) risk groups. The primary outcome was the development of stage 1+ hypertension, defined as blood pressure levels of at least 130/80 mm Hg or the use of antihypertensive medication at 2 to 7 years post partum. The mean age of the participants was 30.8 years, and 12.4% had a prior history of HDP.
Among the 2852 participants, 509 (17.8%) developed hypertension at a mean of 3.2 years after delivery. The analysis revealed that high SBP genetic risk was independently associated with incident hypertension when compared with low genetic risk (adjusted odds ratio [aOR], 1.50; 95% CI, 1.09-2.07; P = .01).
However, when the data were stratified by pregnancy history, the association remained significant only for women without prior HDP (aOR, 1.25; 95% CI, 1.12-1.40 per SD; P < .001). For those with a history of HDP, the genetic score did not significantly stratify the risk of new-onset hypertension (aOR, 1.01; 95% CI, 0.79-1.28 per SD; P = .92).
The researchers further compared the population attributable risk (PAR) for various factors to determine their relative impact on hypertension development. High SBP genetic risk accounted for 4.7% of the PAR, whereas a history of HDP accounted for 10.8%. Notably, a BMI of 25 or greater represented the largest contributor, accounting for 41.5% of the population attributable risk for hypertension.
Limitations included that only nulliparous individuals were included. Additionally, the investigators noted that BMI is an “imperfect proxy for adiposity distribution or degree of visceral adiposity that may better reflect obesity-associated hypertension and CVD risk.” The population risk framework assumed homogeneity of associated risk across the population, potentially creating an oversimplification, and lastly, the sample size of those with prior HDP was “modest.”
“HDP history and postpartum BMI were both stronger determinants of hypertension risk,” the authors concluded. “These findings highlight pregnancy and the postpartum period as an opportunity to assess and optimize cardiometabolic health toward long-term prevention of CVD, including in those without HDP.”
Reference:
Hemeryck J, De Moor N, Ezzat D, et al. Blood Pressure Genetic Risk and Incident Hypertension at 2 to 7 Years Post Partum. JAMA Cardiol. Published online April 01, 2026. doi:10.1001/jamacardio.2026.0363
