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Abstract

Pre-eclampsia, a condition characterized by new-onset hypertension during pregnancy and one or more indices of organ damage, is a major driver of both short and long-term maternal health outcomes. Individuals with a history of pre-eclampsia are at increased risk for cardiovascular, renal, and other chronic diseases. Recent studies have linked pre-eclampsia history with increased risk of dementia later in life, underscoring the importance of new guidelines emphasizing blood pressure control to reduce the risk of cognitive decline. Unfortunately, neither mechanisms underlying causes of pre-eclampsia nor their links with cognitive function are well understood. Vascular contributions to cognitive impairment and dementia (VCID) is a type of dementia caused by reduced cerebral blood flow, often resulting from vascular dysfunction associated with small vessel damage or chronic hypertension. The renin angiotensin-aldosterone system (RAAS) is a hormone system with a major role in regulating blood pressure, fluid homeostasis, and vascular function inside and outside of pregnancy. The RAAS is markedly activated during pregnancy; pre-eclampsia is associated with disruptions in the normal activity of the RAAS, including excessive angiotensin (Ang) II type 1 receptor signaling, and loss of protective effects of Ang-(1-7) and Ang II type 2 receptors. Pre-existing hypertension may impair the normal RAAS response to pregnancy, increasing susceptibility for vascular damage both during and after pregnancy. Results from human and animal studies indicate that dysregulation of the RAAS is a shared pathway underlying vascular dysfunction in both pre-eclampsia and VCID, suggesting a mechanistic link between these two conditions. Persistent endothelial damage, impaired vascular remodeling, and chronic activation of Ang II type 1 and mineralocorticoid receptor signaling may increase long-term risk. This connection underscores the importance of monitoring and managing blood pressure during pregnancy, and in women with a history of pre-eclampsia in order to mitigate the risk of dementia.

Document Type

Article

Publication Date

Spring 2-19-2026

Notes/Citation Information

Arteriosclerosis, Thrombosis, and Vascular Biology. Feb 19 2026. Online ahead of Press

Digital Object Identifier (DOI)

10.1161/ATVBAHA.125.321675

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