Introduction:
Preeclampsia is a pregnancy-related hypertensive disorder with long-term cardiovascular risks. The aim of this study was to explore the influencing factors of hypertension progression in preeclampsia patients within five years postpartum, and to construct a nomogram.

Material and methods:
A retrospective study of 280 preeclampsia patients, grouped by hypertension progression status within 5 years postpartum. Differential analyses compared: 1) demographic/pregnancy characteristics, and 2) late-pregnancy, 1-week-postpartum,and 6-week-postpartum blood indicators between groups. Multiple logistic regression and generalized estimating equations (GEE) identified hypertension progression factors. Significant factors built a nomogram evaluated via calibration and receiver operating characteristic (ROC) curves in training/test sets.

Results:
Patients who progress to hypertension have higher pre-pregnancy and postpartum body mass index (BMI), a greater proportion of early-onset and severe preeclampsia, and a higher incidence of adverse pregnancy outcomes compared to those who do not progress to hypertension. Additionally, they have lower platelet levels during late pregnancy and postpartum, while levels of aspartate aminotransferase, alanine aminotransferase, 24-hour urinary protein, uric acid, and C-reactive protein are higher in patients who do not progress to hypertension. Multivariate logistic regression identified placental abruption, oligohydramnios, and umbilical artery pulsatility index as significant factors, while the generalized estimating equation highlighted uric acid, platelet, and alanine aminotransferase as key predictors. The nomogram demonstrated good predictive performance, as shown by calibration and ROC curves.

Conclusions:
Hypertension progression correlates with placental abruption, oligohydramnios, elevated UA-PI, elevated UA, decreased PLT, elevated ALT, and specifically postpartum 1-week AST. The nomogram aids early identification of high-risk patients.