Garovic, Vesna D. (6603419874)Vesna D. (6603419874)GarovicWhite, Wendy M. (54279565800)Wendy M. (54279565800)WhiteVaughan, Lisa (56527921700)Lisa (56527921700)VaughanSaiki, Mie (57204721885)Mie (57204721885)SaikiParashuram, Santosh (57204718692)Santosh (57204718692)ParashuramGarcia-Valencia, Oscar (57205373508)Oscar (57205373508)Garcia-ValenciaWeissgerber, Tracey L. (6506688349)Tracey L. (6506688349)WeissgerberMilic, Natasa (7003460927)Natasa (7003460927)MilicWeaver, Amy (57203179699)Amy (57203179699)WeaverMielke, Michelle M. (7004869517)Michelle M. (7004869517)Mielke2025-06-122025-06-122020https://doi.org/10.1016/j.jacc.2020.03.028https://www.scopus.com/inward/record.uri?eid=2-s2.0-85083772223&doi=10.1016%2fj.jacc.2020.03.028&partnerID=40&md5=b7a837ce8de1101b3e4155c45b62702dhttps://remedy.med.bg.ac.rs/handle/123456789/4949Background: Hypertensive disorders of pregnancy (HDP) are associated with increased risks for cardiovascular disease later in life. The HDP incidence is commonly assessed using diagnostic codes, which are not reliable; and typically are expressed per-pregnancy, which may underestimate the number of women with an HDP history after their reproductive years. Objectives: This study sought to determine the incidence of HDP expressed as both per-pregnancy and per-woman, and to establish their associations with future chronic conditions and multimorbidity, a measure of accelerated aging, in a population-based cohort study. Methods: Using the Rochester Epidemiology Project medical record-linkage system, the authors identified residents of Olmsted County, Minnesota, who delivered between 1976 and 1982. The authors classified pregnancies into normotensive, gestational hypertension, pre-eclampsia, eclampsia, pre-eclampsia superimposed on chronic hypertension, and chronic hypertension using a validated electronic algorithm, and calculated the incidence of HDP both per-pregnancy and per-woman. The risk of chronic conditions between women with versus those without a history of HDP (age and parity 1:2 matched) was quantified using the hazard ratio and corresponding 95% confidence interval estimated from a Cox model. Results: Among 9,862 pregnancies, we identified 719 (7.3%) with HDP and 324 (3.3%) with pre-eclampsia. The incidence of HDP and pre-eclampsia doubled when assessed on a per-woman basis: 15.3% (281 of 1,839) and 7.5% (138 of 1,839), respectively. Women with a history of HDP were at increased risk for subsequent diagnoses of stroke (hazard ratio [HR]: 2.27; 95% confidence interval [CI]: 1.37 to 3.76), coronary artery disease (HR: 1.89; 95% CI: 1.26 to 2.82), cardiac arrhythmias (HR: 1.62; 95% CI: 1.28 to 2.05), chronic kidney disease (HR: 2.41; 95% CI: 1.54 to 3.78), and multimorbidity (HR: 1.25; 95% CI: 1.15 to 1.35). Conclusions: The HDP population-based incidence expressed per-pregnancy underestimates the number of women affected by this condition during their reproductive years. A history of HDP confers significant increase in risks for future chronic conditions and multimorbidity. © 2020 American College of Cardiology Foundationcardiovascular diseasehypertensive disorders of pregnancyincidencemultimorbidity