From Hypertensive Pregnancy to Cardiovascular Prevention: Postpartum Risk Stratification and Long-Term Primary Care

Abstract

Hypertensive disorders of pregnancy are increasingly recognized as early indicators of long-term maternal cardiovascular vulnerability rather than conditions limited to gestation. This study analyzed the association between hypertensive disorders of pregnancy and subsequent cardiovascular risk, with particular emphasis on postpartum surveillance and preventive strategies within primary care. A structured integrative review based on the Scientific Method was performed using evidence from systematic reviews, meta-analyses, cohort studies, scientific statements, and clinical publications addressing preeclampsia, gestational hypertension, chronic hypertension, cardiovascular outcomes, and postpartum follow-up. The analyzed evidence consistently demonstrated increased risks of chronic hypertension, ischemic heart disease, heart failure, stroke, cardiovascular hospitalization, and cardiovascular mortality after hypertensive pregnancy. Heart failure showed some of the highest relative effect estimates, while chronic hypertension emerged as one of the most frequent and earliest abnormalities identified during follow-up. Recurrent preeclampsia was associated with an even greater cardiovascular burden than a single affected pregnancy, supporting recurrence as a relevant marker for risk stratification. Postpartum studies also showed that hypertension, prediabetes, hyperlipidemia, and type 2 diabetes can be detected within the first years after delivery, particularly when early screening and primary-care follow-up are implemented. These findings support a longitudinal model in which obstetric history is incorporated into cardiovascular prevention, with early postpartum blood pressure assessment, cardiometabolic surveillance, lifestyle intervention, and sustained follow-up through primary care. Coordination between obstetrics and gynecology, family medicine, and cardiology is essential to maintain continuity of care and identify women who may benefit from intensified surveillance. Hypertensive disorders of pregnancy therefore represent an opportunity for early cardiovascular risk recognition and prevention across the maternal life course.