Hypertensive Disorders of Pregnancy and Cardiovascular-Kidney-Metabolic Syndrome

BACKGROUND: Hypertensive disorders of pregnancy (HDP) affect over 10% of pregnancies worldwide, but their association with cardiovascular-kidney-metabolic (CKM) syndrome remains unexplored. METHODS: The present study included parous UK Biobank participants. The primary exposure was HDP history. CKM syndrome was categorized from stage 0 (no risk factors) to 4 (cardiovascular disease). Logistic regression tested the association of HDP history with CKM stage, adjusted for age, age 2 , race, Townsend Deprivation Index, and smoking status. Cox models evaluated progression to stage 4, in addition, adjusting for baseline CKM stage. Replication analyses were performed in the Women Health Initiative, with CKM stage assessed at 2 study visits. RESULTS: Among 219 639 UK Biobank (mean age, 56.9 years) and 3591 Women Health Initiative participants (61.7 years at baseline, 78.1 years at the follow-up visit), 2836 (1.3%) and 304 (8.4%), respectively, had a history of HDP. In the UK Biobank, HDP history was significantly associated with higher CKM stage (adjusted odds ratio, 3.40 [95% CI, 3.12–3.71]; P <0.001) in ordinal logistic regression. Compared with CKM stage 0, HDP history was associated with higher odds of stages 2 to 4 (adjusted odds ratios, 6.34, 11.20, and 7.43, respectively; all P <0.001). Over a median follow-up of 13.6 years, prior HDP was associated with progression to stage 4 (adjusted hazard ratio, 1.24 [95% CI, 1.10–1.40]; P <0.001). Replication in the Women Health Initiative produced consistent results. CONCLUSIONS: HDP history was associated with greater CKM stage and progression to advanced CKM syndrome, supporting its use as an early life predictor of adverse CKM trajectories.

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Journal
Hypertension
Published
2026-09-21
DOI
https://doi.org/10.1161/hypertensionaha.126.27750
Primary Topic
Pregnancy and preeclampsia studies
Type
article
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article

Hypertensive Disorders of Pregnancy and Cardiovascular-Kidney-Metabolic Syndrome

Nisha I. Parikh, Maria A. Pabón, Michael C. Honigberg, Zhi Yu et al.
Hypertension
Pregnancy and preeclampsia studies
article

Hypertensive Disorders of Pregnancy and Cardiovascular-Kidney-Metabolic Syndrome

Nisha I. Parikh, Maria A. Pabón, Michael C. Honigberg, Zhi Yu, Erin S. LeBlanc, Michael J. LaMonte, Charles B. Eaton, Pradeep Natarajan, JoAnn E. Manson, Diana C. Soria‐Contreras, So Mi Jemma Cho, Rosângela Akemi Hoshi, Marcia L. Stefanick, Samia Mora, Alex P. Reiner, Jason D. Roh, Camille Elise Powe, Olga Demler, Daniel Ezzat, Linke Li, Cassandra N. Spracklen, Nore De Moor, Annie Chang
article en

Abstract

BACKGROUND: Hypertensive disorders of pregnancy (HDP) affect over 10% of pregnancies worldwide, but their association with cardiovascular-kidney-metabolic (CKM) syndrome remains unexplored. METHODS: The present study included parous UK Biobank participants. The primary exposure was HDP history. CKM syndrome was categorized from stage 0 (no risk factors) to 4 (cardiovascular disease). Logistic regression tested the association of HDP history with CKM stage, adjusted for age, age 2 , race, Townsend Deprivation Index, and smoking status. Cox models evaluated progression to stage 4, in addition, adjusting for baseline CKM stage. Replication analyses were performed in the Women Health Initiative, with CKM stage assessed at 2 study visits. RESULTS: Among 219 639 UK Biobank (mean age, 56.9 years) and 3591 Women Health Initiative participants (61.7 years at baseline, 78.1 years at the follow-up visit), 2836 (1.3%) and 304 (8.4%), respectively, had a history of HDP. In the UK Biobank, HDP history was significantly associated with higher CKM stage (adjusted odds ratio, 3.40 [95% CI, 3.12–3.71]; P <0.001) in ordinal logistic regression. Compared with CKM stage 0, HDP history was associated with higher odds of stages 2 to 4 (adjusted odds ratios, 6.34, 11.20, and 7.43, respectively; all P <0.001). Over a median follow-up of 13.6 years, prior HDP was associated with progression to stage 4 (adjusted hazard ratio, 1.24 [95% CI, 1.10–1.40]; P <0.001). Replication in the Women Health Initiative produced consistent results. CONCLUSIONS: HDP history was associated with greater CKM stage and progression to advanced CKM syndrome, supporting its use as an early life predictor of adverse CKM trajectories.

Hypertension
Broad Institute (US), Brigham and Women's Hospital (US), Northwell Health (US), Cape Town HVTN Immunology Laboratory / Hutchinson Centre Research Institute of South Africa (ZA), Harvard University (US), Yonsei University (KR), University of Massachusetts Amherst (US), Brown University (US), Kent Hospital (US), Ghent University (BE), ETH Zurich (CH), Fred Hutch Cancer Center (US), Kaiser Permanente Center for Health Research (US), University at Buffalo, State University of New York (US), Stanford University (US), Icahn School of Medicine at Mount Sinai (US), KU Leuven (BE)
Good health and well-being
Openalex Percentile: Top 8%
Pregnancy and preeclampsia studies
DOISourceOpenAlex
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