Hypertensive Disorders of Pregnancy and Future Peripheral Vascular Disease

Hypertensive disorders of pregnancy (HDP) are major contributors to maternal morbidity and mortality, with established links to cardiovascular disease. However, the relationship between HDP and peripheral arterial disease (PAD) is poorly defined. This review summarizes available literature on PAD risk following HDP, outlines proposed mechanistic pathways, and identifies key research gaps.

A PubMed search identified studies published between 2014 and April 2024 examining HDP and subsequent vascular outcomes. Titles and abstracts were screened for relevance to PAD, and findings were synthesized to highlight risk estimates, mechanisms, and areas requiring further investigation.

Of the 173 identified articles, most addressed cardiovascular disease, with only five specifically evaluating PAD. Evidence on PAD risk is sparse, and definitions and methodologies vary widely across studies. Proposed mechanisms include structural vascular changes, inflammation, impaired angiogenesis, and metabolic disturbances, all converging on a persistent endothelial dysfunction as the final common pathway that may predispose to PAD.

HDP may be a marker of long-term PAD risk, but current data are limited. Standardized outcome definitions, mechanistic biomarker studies, and PAD-specific cohort analyses are needed to clarify this relationship. Early postpartum surveillance of metabolic and vascular risk factors in women with prior HDP may provide opportunities for timely intervention. This review emphasizes the underrecognized association between HDP and PAD and outlines priorities for future research.