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Women who have hypertension during pregnancy do not receive adequate follow-up care from their primary care clinicians, despite being at higher risk for long-term cardiovascular issues, according to research presented at the Society of General Internal Medicine (SGIM) 2026 Annual Meeting in Washington, DC.

In 2024, The American Heart Association called for clinicians to monitor patients who had hypertension in pregnancy and provide education on how to reduce their long-term risks with lifestyle changes. The new findings indicate missed opportunities for clinicians to identify cardiovascular issues earlier on.

“The issue is that people that have had any of these [hypertension] conditions are at increased future cardiovascular disease risk, and this starts as early as the first year postpartum but also persists across the rest of the life course,” said Laura Attanasio, PhD, associate professor of health policy and management at the University of Massachusetts Amherst, who led the study. “The most appropriate place to manage that risk is likely primary care,” she noted.

Hypertension disorders in pregnancy, such as preeclampsia and HELLP syndrome, complicate up to 15% of pregnancies in the US. Hypertension during pregnancy is a leading cause of maternal death and is associated with long-term development of heart failure, coronary artery disease, and stroke. Preeclampsia can also lead to development of chronic hypertension in the decade after pregnancy.

The cross-sectional analysis of data from the 2021 and 2023 Behavioral Risk Factor Surveillance System included women in the first 5 years following childbirth (n = 3319; 56% White; average age, 29.8 years) who had hypertension only during or before pregnancy (chronic) or no hypertension.

Women with chronic hypertension had a 9 percentage-point higher probability of having a personal doctor (P < .01) and a 19 percentage-point higher probability of having received a cholesterol check within the past year than women with no hypertension or pregnancy-only hypertension (P < .01). No differences were observed between women with no hypertension and women who only had hypertension during pregnancy.

Attanasio hypothesized several factors might contribute to the disparities, including a lack of uniform guidelines on how often postpartum hypertensive women should receive cholesterol checks and how to monitor patients with this specific history.

Clinicians need to initiate comprehensive surveillance of blood pressure and cholesterol levels during fourth-trimester check-ups and continue that surveillance during annual visits, said Julia Carp, MD, primary care and internal medicine resident at Weill Cornell Medicine Center in New York City.

“It’s on the onus of us as PCPs [primary care physicians] to manage and be aware of what all of the complications and risks are for these patients,” said Carp, who presented a case study on best practices in monitoring this population at SGIM.

At an initial visit with a patient who is postpartum, clinicians should ask questions about pregnancy-related complications and “document that and make sure that it does not leave the health record,” Carp said. “It should be something that stays, so that it can be used for future surveillance.”

At the meeting, Carp presented a case study of a 28-year-old woman who established care with her in 2025 at 8 weeks postpartum. The patient had preeclampsia during pregnancy. They discussed the long-term consequences of pregnancy-related hypertension and established a plan to monitor the patient’s blood pressure and weight because the patient had a history of obesity and a BMI of 41. Obesity is another risk factor for cardiovascular disease.

Carp ordered a prescription blood pressure cuff and instructed the patient to monitor her blood pressure daily at home. She also set an appointment for 6 months later. 

Moving forward, Carp said she will monitor the patient’s cholesterol levels annually at minimum, but possibly more frequently depending on the patient’s ability to decrease her BMI. 

“Get people engaged with their care and also to stay connected with their PCP, which is the ultimate goal because this is a lifelong relationship that we need to foster,” Carp said.

Attanasio’s study was funded by the National Institutes of Health. Carp’s study did not receive funding. Attanasio and Carp reported having no relevant financial disclosures. 

Kelsey Mesmer, PhD, is a freelance journalist and professor of journalism at Saint Louis University, Saint Louis.