Key result
Parous Black women face ~2.7-fold higher hypertension incidence compared to White women.
Why the study?
Few studies have examined how intersecting social and sex-based biological determinants influence hypertension incidence among parous individuals and across racial groups.
Do traditional cardiovascular risk factors, female-specific risk factors, and social drivers of health explain the disparity in hypertension risk after pregnancy between Black and White women?
Cohort (n=1,653)
Do traditional cardiovascular risk factors, female-specific risk factors, and social drivers of health explain the disparity in hypertension risk after pregnancy between Black and White women?
Hazard Ratio: 2.72 (95% CI 2.17–3.41)
Absolute Event Rate: 41.4% vs 18.5%
Parous Black women face a substantially higher incidence and earlier onset of hypertension compared to White women, a disparity that remains largely unexplained by traditional, female-specific, and social drivers of health.
Parous Black women merit closer post-pregnancy hypertension surveillance; leaves open unidentified contributors to racial disparities.
BACKGROUND: Hypertension is the leading risk factor for cardiovascular disease, with disparities observed by race. Few studies have examined how intersecting social and sex-based biological determinants influence hypertension incidence among parous individuals and across racial groups. The objective of this study was to examine whether female-specific cardiovascular disease risk factors (eg, adverse pregnancy outcomes), individual-level (eg, education), and structural-level (eg, neighborhood) social drivers of health (SDoH), beyond traditional cardiovascular disease risk factors (eg, physical activity), explain the Black-White disparity in hypertension following pregnancy. METHODS: Parous individuals in CARDIA (Coronary Artery Risk Development in Young Adults), a longitudinal cohort study beginning in 1985 to 1986, without hypertension before their first pregnancy were included. Race was self-reported at enrollment. Blood pressure was measured at each examination, with hypertension incidence defined as the first elevated blood pressure (systolic ≥130 mm Hg or diastolic ≥80 mm Hg) or initiation of antihypertensive medication after baseline. Participant follow-up time began at the next exam following their first live delivery. Cox proportional hazards models with time-varying covariates calculated hazard ratios and 95% CIs. To quantify how much each set of covariates explained the Black-White difference in hypertension risk, the percentage reduction in the race coefficient was calculated following the addition of female-specific cardiovascular disease risk factors and SDoH in multivariable-adjusted regression models. RESULTS: Among 1653 participants (29.4±6.1 years), Black women (n=924) had higher hypertension incidence than White women (n=729): 41.4 versus 18.5 per 1000 person-years, respectively; and an earlier median age at onset (42 versus 48 years). Following traditional risk factors, individual-level SDoH explained the largest disparity (7.52%), followed by female-specific factors (2.26%) and structural-level SDoH (1.50%). Black women remained at higher risk after adjustment (hazard ratio, 2.72 [95% CI, 2.17-3.41]). CONCLUSIONS: Parous Black women face substantially higher hypertension rates than White women, persisting after accounting for traditional risk factors, female-specific risk factors, and SDoH.
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Dziewior et al. (2026) conducted a cohort in Hypertension (n=1,653). Black race vs. White race was evaluated on Hypertension incidence (first elevated blood pressure ≥130/80 mm Hg or initiation of antihypertensive medication) (HR 2.72, 95% CI 2.17-3.41). Parous Black women had a higher incidence of hypertension than White women (adjusted HR 2.72; 95% CI 2.17-3.41), which persisted after accounting for traditional, female-specific, and social factors.
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