Hypertensive disorders of pregnancy (HDP), including preeclampsia and gestational hypertension, are linked to earlier development of chronic hypertension. A cohort study published in JAMA Cardiology evaluated whether genetic predisposition to higher systolic blood pressure (SBP) is associated with new-onset hypertension 2 to 7 years after delivery, independent of clinical characteristics and HDP history.

This study included genotyped women without pregestational chronic hypertension from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b) Heart Health Study across 8 US clinical sites. Participants were enrolled during pregnancy between 2010 and 2013 and followed for 2 to 7 years postpartum. SBP genetic risk was assessed using a genome-wide polygenic score and categorized as low, intermediate, or high. The primary outcome was stage 1 or higher hypertension, defined as blood pressure ≥130/80 mm Hg or use of antihypertensive medication. Analyses were adjusted for sociodemographic factors, prepregnancy diabetes, first-trimester blood pressure, HDP history, and postpartum body mass index (BMI).

Among 2852 participants (mean [SD] age, 30.8 [5.5] years; 353 [12.4%] with prior HDP), 509 (17.8%) developed hypertension at a mean (SD) of 3.2 (0.9) years after delivery. High SBP genetic risk was associated with incident hypertension compared with low risk (adjusted odds ratio [aOR] 1.50; 95% CI 1.09-2.07; P=0.01). In stratified analyses, SBP genetic risk was associated with incident hypertension in participants without prior HDP (aOR 1.25 per SD; 95% CI 1.12-1.40; P<0.001), but not in those with prior HDP (aOR 1.01; 95% CI 0.79-1.28; P=0.92; P for interaction=0.10). Population attributable risk was 4.7% for genetic risk, 10.8% for HDP history, and 41.5% for BMI ≥25.

These findings indicate that higher SBP genetic risk is associated with new-onset hypertension after pregnancy, although HDP history and elevated BMI contribute more substantially to overall hypertension risk.