Abstract Body: Introduction: Experiences of discrimination are associated with increased risk of preeclampsia during pregnancy and cardiovascular disease later in life. We examined the association of discrimination with hypertension in the years after pregnancy.

Methods: Participants (n=580) were recruited at Magee-Womens Hospital (Pittsburgh PA) with births in 2008-2012 and questionnaires (Everyday Discrimination Scale [EDS], health history, demographics) completed in 2024 (mean age 43 years). Prior preeclampsia was abstracted from medical records. Self-identified race was Black (n=150) compared to a composite of non-Black (White [n=415], Latina [n=6] or Asian [n=9]) due to small numbers of some groups. Outcome was self-reported hypertension, validated in a subset (n=171) with measured blood pressure following a standardized protocol (positive and negative predictive values were 91% and 59%, respectively). Logistic models estimated the association between discrimination and hypertension after pregnancy adjusted for age, education, preeclampsia, and body mass index; results were stratified by race.

Results: Black women were younger (39.2 ±6 vs. 43.6 ±6), more likely to have a high school education or less (36.9% vs. 12.9%), more likely to report current hypertension (31.1% vs. 16.7%, p=0.0002) and had higher discrimination scores (22.5 ±10.9 vs. 17.7 ±7.2, p<0.001) than non-Black women. Black women indicated the main reason for discrimination was race or ancestry (69.4% vs. 6.8%; p <0.001); non-Black women reported the main reason was gender (32.6% vs. 18.0%; p= 0.007). Each unit increase in discrimination was associated with 2.4% increased odds of hypertension, adjusted for age, education, and preeclampsia (aOR 1.024, 95% CI 1.0, 1.049, p=0.05), and BMI (aOR 1.029, 95% CI 0.99, 1.06). The magnitude of this association was similar to that of age (aOR 1.06, 95% CI 1.02, 1.11 per year). The association between discrimination and hypertension was restricted to Black women (aOR 1.027, 95% CI 0.99, 1.06; p=0.130) and was not detected in non-Black women (aOR 0.995, 95% CI 0.96, 1.04; p=0.816).

Discussion: Black women reported higher discrimination in the years after pregnancy that was related to higher rates of hypertension, independent of prior preeclampsia and other risk factors. It is imperative to understand the biological implications of discrimination, particularly during pregnancy, which may provide a unique view of the impacts of racism on cardiovascular health.