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Peer-reviewedCC BY 4.0Frontiers in Cardiovascular Medicine

Long-term multisystem organ damage following hypertensive disorders of pregnancy across clinical risk subgroups: a UK Biobank study

  • Mina Hmimas1,2
  • Adriana Angarita-Fonseca2
  • Abhinav Sharma2,3
  • Colin Berry4
  • Amanpreet Kaur2,5
  • Yusheng Zhou2,6
  • Tomas Mavrakanas2,3
  • Maria Natasha Rajah7,8
  • Louise Pilote2,3
8 affiliations
  1. 1Faculty of Medicine and Health Sciences, McGill University
  2. 2Research Institute of McGill University Health Centre, McGill University
  3. 3Department of Medicine, McGill University
  4. 4School of Cardiovascular and Metabolic Health, University of Glasgow
  5. 5Dalla Lana School of Public Health, University of Toronto
  6. 6KITE Research Institute, University Health Network, University of Toronto
  7. 7Department of Psychiatry, McGill University
  8. 8Department of Psychology, Toronto Metropolitan University
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Abstract

Background: Hypertensive disorders of pregnancy (HDP) are associated with increased long-term cardiovascular, cerebrovascular, and renal risk, yet pathways linking HDP to later organ damage remain poorly understood. Persistent vascular dysfunction after HDP and subsequent cardiovascular risk factors may contribute to long-term hypertension-mediated organ damage (HMOD). We evaluated associations between HDP and long-term cerebral, cardiac, vascular, and renal HMOD across clinically relevant risk subgroups.

Methods: In this UK Biobank matched cohort study, parous females with a history of HDP were matched 1:4 to females without HDP by age at first delivery and parity. HMOD was assessed using white matter hyperintensity volume, left ventricular ejection fraction, pulse wave arterial stiffness index, and urine albumin-to-creatinine ratio. Multivariate linear regression models adjusted for cardiovascular risk factors assessed associations between HDP and each HMOD marker. Analyses were stratified by subsequent hypertension, menopausal status, age ≥50 years, antihypertensive medication use, and time since HDP ≥10 years.

Results: Among participants (mean age 50 ± 7 years), HDP was not associated with white matter hyperintensity volume ( β = −0.31, 95% CI −1.04 to 0.41, p = 0.401), left ventricular ejection fraction ( β = 0.76, 95% CI −0.38 to 1.90, p = 0.193), pulse wave arterial stiffness index ( β = 0.14, 95% CI −0.36 to 0.64, p = 0.595), or urine albumin-to-creatinine ratio ( β = −0.12, 95% CI −0.51 to 0.26, p = 0.535) after multivariate adjustment. Subgroup analyses revealed an isolated significant adjusted association with lower log-transformed white matter hyperintensity volume among participants with subsequent hypertension ( β = −0.41, 95% CI −0.79 to −0.03, p = 0.033), while other associations were not consistently significant.

Discussion: HDP was not consistently associated with selected measures of long-term subclinical HMOD across clinically relevant subgroups. Established long-term cardiovascular and renal risks following HDP may not be uniformly reflected by HMOD markers assessed at a single time point later in life. Future longitudinal studies using repeated assessments are needed to identify which HMOD phenotypes emerge following HDP and whether they predict or mediate subsequent cardiovascular, cerebrovascular, and renal outcomes.

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Cite

BibTeXRIS
BibTeX
@article{hmimas2026longterm,
  title = {{Long-term multisystem organ damage following hypertensive disorders of pregnancy across clinical risk subgroups: a UK Biobank study}},
  author = {Mina Hmimas and Adriana Angarita-Fonseca and Abhinav Sharma and Colin Berry and Amanpreet Kaur and Yusheng Zhou and Tomas Mavrakanas and Maria Natasha Rajah and Louise Pilote},
  journal = {Frontiers in Cardiovascular Medicine},
  year = {2026},
  month = nov,
  doi = {10.3389/fcvm.2026.1996732},
  url = {https://www.frontiersin.org/articles/10.3389/fcvm.2026.1996732/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Long-term multisystem organ damage following hypertensive disorders of pregnancy across clinical risk subgroups: a UK Biobank study
AU  - Mina Hmimas
AU  - Adriana Angarita-Fonseca
AU  - Abhinav Sharma
AU  - Colin Berry
AU  - Amanpreet Kaur
AU  - Yusheng Zhou
AU  - Tomas Mavrakanas
AU  - Maria Natasha Rajah
AU  - Louise Pilote
PY  - 2026
DA  - 2026/11/06
JO  - Frontiers in Cardiovascular Medicine
DO  - 10.3389/fcvm.2026.1996732
UR  - https://www.frontiersin.org/articles/10.3389/fcvm.2026.1996732/full
AB  - Background: Hypertensive disorders of pregnancy (HDP) are associated with increased long-term cardiovascular, cerebrovascular, and renal risk, yet pathways linking HDP to later organ damage remain poorly understood. Persistent vascular dysfunction after HDP and subsequent cardiovascular risk factors may contribute to long-term hypertension-mediated organ damage (HMOD). We evaluated associations between HDP and long-term cerebral, cardiac, vascular, and renal HMOD across clinically relevant risk subgroups.  Methods: In this UK Biobank matched cohort study, parous females with a history of HDP were matched 1:4 to females without HDP by age at first delivery and parity. HMOD was assessed using white matter hyperintensity volume, left ventricular ejection fraction, pulse wave arterial stiffness index, and urine albumin-to-creatinine ratio. Multivariate linear regression models adjusted for cardiovascular risk factors assessed associations between HDP and each HMOD marker. Analyses were stratified by subsequent hypertension, menopausal status, age ≥50 years, antihypertensive medication use, and time since HDP ≥10 years.  Results: Among participants (mean age 50 ± 7 years), HDP was not associated with white matter hyperintensity volume ( β = −0.31, 95% CI −1.04 to 0.41, p = 0.401), left ventricular ejection fraction ( β = 0.76, 95% CI −0.38 to 1.90, p = 0.193), pulse wave arterial stiffness index ( β = 0.14, 95% CI −0.36 to 0.64, p = 0.595), or urine albumin-to-creatinine ratio ( β = −0.12, 95% CI −0.51 to 0.26, p = 0.535) after multivariate adjustment. Subgroup analyses revealed an isolated significant adjusted association with lower log-transformed white matter hyperintensity volume among participants with subsequent hypertension ( β = −0.41, 95% CI −0.79 to −0.03, p = 0.033), while other associations were not consistently significant.  Discussion: HDP was not consistently associated with selected measures of long-term subclinical HMOD across clinically relevant subgroups. Established long-term cardiovascular and renal risks following HDP may not be uniformly reflected by HMOD markers assessed at a single time point later in life. Future longitudinal studies using repeated assessments are needed to identify which HMOD phenotypes emerge following HDP and whether they predict or mediate subsequent cardiovascular, cerebrovascular, and renal outcomes.
SN  - 2297-055X
ER  -