Cardiovascular maladaptation in women with hypertensive disorders of pregnancy and long-term cardiovascular risk

Hypertensive disorders of pregnancy are a leading cause of maternal and perinatal morbidity and mortality. Pregnancy is increasingly viewed as a physiological "stress test" capable of revealing latent cardiovascular susceptibility in women predisposed to future cardiovascular disease. In hypertensive disorders of pregnancy, this vulnerability becomes clinically evident as impaired cardiovascular adaptation during pregnancy. It remains uncertain whether women who develop both hypertensive disorders of pregnancy and cardiovascular disease share common pre-existing risk factors or whether hypertensive disorders of pregnancy contribute directly to long-term cardiovascular impairment. In normotensive pregnancy, systemic vascular resistance declines, blood volume and cardiac output increase significantly, and the heart undergoes reversible structural remodeling. In contrast, hypertensive disorders of pregnancy are characterized by abnormal placentation, angiogenic imbalance, endothelial dysfunction, disrupted maternal hemodynamic balance, and adverse cardiac remodeling. Importantly, these maladaptive cardiovascular changes may persist well beyond delivery, leading to prolonged ventricular dysfunction and chronic cardiovascular changes. This review focuses on the cardiovascular maladaptation in hypertensive disorders of pregnancy and its long-term effects on affected women and their offspring, as well as targeted interventions to reduce the risk of hypertensive disorders of pregnancy and subsequent cardiovascular disease.