Hypertensive disorders of pregnancy (HDP) are a leading cause of maternal and foetal morbidity and mortality. We aimed to estimate the impact of HDP on the onset of permanent hypertension in primiparous women in the first years following childbirth.

This nationwide cohort study used data from the French National Health Data System (SNDS). All eligible primiparous women without pre-existing chronic hypertension who delivered between 2010 and 2018 were included. Women were followed up from six weeks postpartum until onset of hypertension, a cardiovascular event, death or the study end date (31 December 2018). The main outcome was a diagnosis of permanent hypertension. We used Cox models to estimate hazard ratios of permanent hypertension for all types of HDP.

Overall, 2,663,573 women were included with a median follow-up time was 4.6 years. Among them, 180,063 (6.8%) had an HDP. Specifically 57,595 (2.2%) had preeclampsia (PE), 113,803 (4.3%) had gestational hypertension (GH). Compared with women who had no HDP, the fully-adjusted hazard ratios (HR) of those with permanent hypertension were 5.45 [95% CI: 5.34–5.56] and 6.95 [6.37–7.58] for GH and PE, respectively. Among women with PE, HR were 1.67 [95% CI: 1.53–1.82], 1.34 [95% CI: 1.25–1.44] and 2.66% [95% CI: 2.46–2.87] for early PE, severe PE, and PE following GH, respectively. HDP exposure duration was a major risk factor of permanent hypertension for all PE subgroups, but not for GH. Women with HDP consulted a general practitioner or cardiologist more frequently and earlier (Fig. 1).

HDP exposure greatly increased the risk of permanent hypertension in the first years following delivery.