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Subtypes of Hypertension 2 to 7 Years After First Pregnancy

Laura H Brubaker1, Janet M Catov2, C Noel Bairey Merz3

  • 1Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences (L.H.B., H.S.), University of Pittsburgh School of Medicine, PA.

Hypertension (Dallas, Tex. : 1979)
|June 9, 2026
PubMed

Insights

Isolated diastolic hypertension is common after pregnancy. Hypertensive disorders of pregnancy increase the risk of both isolated diastolic and combined hypertension, highlighting opportunities for cardiovascular risk reduction in postpartum women.

Area of Science:

  • Cardiovascular Health
  • Obstetrics and Gynecology
  • Public Health

Background:

  • Isolated diastolic hypertension may precede combined hypertension, indicating potential cardiovascular risk.
  • Prevalence of hypertensive subtypes post-pregnancy and their association with hypertensive disorders of pregnancy is largely unknown.

Purpose of the Study:

  • To determine the prevalence of hypertensive subtypes (isolated diastolic, isolated systolic, combined systolic-diastolic) in the years following first pregnancy.
  • To investigate whether these hypertensive subtypes differ after a hypertensive disorder of pregnancy.

Main Methods:

  • Secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be Heart Health Study (2010-2013).
  • Included nulliparous participants with a follow-up visit 2-7 years postpartum.
  • Used multinomial logistic regression adjusted for age, BMI, race, and time from pregnancy to visit.

Main Results:

  • 19% of 4,302 participants had elevated blood pressure; isolated diastolic hypertension was most prevalent (15%).
  • Hypertensive disorders of pregnancy were associated with increased risk of combined systolic-diastolic hypertension (aRR, 3.09) and isolated diastolic hypertension (aRR, 1.65).

Conclusions:

  • Isolated diastolic hypertension is the most common hypertensive subtype postpartum.
  • Hypertensive disorders of pregnancy increase the risk for both isolated diastolic and combined systolic-diastolic hypertension.
  • Postpartum women, particularly those with a history of hypertensive disorders of pregnancy, represent a key group for cardiovascular risk reduction strategies.
Abstract

Keywords:
blood pressurebody mass indexpregnancypregnancy outcomerisk factors

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