Postpartum blood pressure after hypertensive disorders of pregnancy and subsequent cardiovascular disease: a population-based cohort study

Journal article

Objective To assess the association between blood pressure values at 6 weeks postpartum and subsequent cardiovascular disease (CVD) over a 20-year period among women with hypertensive disorders of pregnancy (HDP).

Design Population-based cohort study

Setting English primary and secondary care data, linked to cause-specific mortality records from 2000 to 2020.

Population A cohort of 39,934 women between 15-49 years of age at birth who had HDP, were registered with a general practitioner (GP) contributing to the Clinical Practice Research Datalink (CPRD), and eligible for linkage to hospital episode statistics(HES) data were included. We excluded 22,100 (55.3%) women with no blood pressure values recorded at 6 weeks postpartum.

Methods Primary analysis included multivariable Cox regression modelling (weighted by the inverse probability of having an HDP).

Main Outcome Measure Validated composite outcome of 12 cardiovascular diseases.

Results The rate for incident cardiovascular events was 109 per 10,000 person-years; 793(68%) of them occurred in women aged less than 40 years. Women with abnormal blood pressure at 6 weeks postpartum had a higher risk of subsequent CVD than women with normal blood pressure:10.9% vs 5.4% - adjusted hazard ratio 1.96(95% CI 1.51 to 2.54).

Conclusions Less than half of women with HDP had a blood pressure record in their GP notes at 6 weeks postpartum. The absence of a record of normal blood pressure at this time point was associated with an increased risk for subsequent CVD The immediate postpartum period may be a crucial window in preventive care to improve women’s health.

Authors: Korb, D; Ramakrishnan, R; Kwok, CH; Li, Y; Carson, C

• Publication status: Accepted
• Peer review status: Peer reviewed
• Publisher: Wiley
• Journal: BJOG: An International Journal of Obstetrics & Gynaecology More from this journal
• Acceptance date: 2026-10-01
• EISSN: 1471-0528
• ISSN: 1470-0328
• Language: English
• Keywords: hypertensive disorders of pregnancy; postpartum blood pressure; cardiovascular disease; blood pressure normalisation