Abstract Body (Do not enter title and authors here): Background: It is well established that hypertensive disorders of pregnancy (HDP) confer downstream risk of cardiovascular (CV) disease. The purpose of this study was to assess long term differences in CV risk among normotensive postpartum females compared to those with different severity of HDP including gestational hypertension, preeclampsia (preE) with and without severe features (preE-Sev), and eclampsia.

Methods: A total of 218,141 live births, among 157,606 unique females from 2017-2024 were studied across 22 Intermountain Health hospitals. Patients were identified by ICD-10 codes and electronic medical records using the MDClone ADAMS platform for those with a history of preexisting chronic hypertension (cHTN) and HDP conditions. Patient groups and sample sizes are displayed in Figure 1. Index dates were defined as first live delivery for the normotensive (no history of HDP) group and first live delivery with HDP for the HDP group. Cox hazard regression assessed the association of patient groups to death and the CV outcomes of incident heart failure (HF), stroke, coronary artery disease (CAD), and myocardial infarction (MI).

Results: A total of 19.7% (n=31,077) of patients had HDP, with the large majority diagnosed at the first live birth (range: 85%-92%). Average age of the population was 28.9±5.5 and the majority white race (86.9%). Patients with HDP had more risk factors compared to normotensive patients (greater BMI, smoking, diabetes, hyperlipidemia, depression, and lower socioeconomic status). Mean follow-up was 4.8±2.3 years. The presence of HDP was associated with increased follow-up CV risk, particularly for incident stroke, HF, CAD and death (Figure 2). This risk increased with worsening HDP severity, with cHTN with superimposed HDP and eclampsia being the most severe.

Conclusions: There is an incremental risk for long-term CV outcomes and death associated with worsening HDP severity. Heightened awareness and systematic aggressive CV risk reduction strategies should be employed among those with HDP.