For a study, the researchers sought to determine if more significant levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) in early pregnancy were linked to hypertensive problems throughout pregnancy and hypertension 2–7 years after delivery. The Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be Heart Health Study, a prospective multicenter observational study, was employed in the cohort study. A total of 4,103 nulliparous women with complete data and no pre-pregnancy hypertension or diabetes were included in the study, who were treated at 8 different clinical sites. Women were tracked for 2 to 7 years after giving birth. Data was collected between October 2010 and October 2017, with analysis between August 2020 and November 2021. The concentration of NT-proBNP in a first-trimester blood sample was determined using an electrochemiluminescence immunoassay. A total of 4,103 women satisfied the criterion for inclusion, with a mean (SD) age of 27.0 (5.6) years. At the follow-up visit, 909 (22.2%) women had a negative pregnancy result, and 817 (19.9%) had hypertension. Higher NT-proBNP levels were linked to a lower risk of hypertensive disorders of pregnancy (adjusted odds ratio per doubling, 0.81; 95% CI, 0.73-0.91), even after controlling for age, self-reported race, and ethnicity, early-pregnancy BMI, smoking, and aspirin use. Similarly, higher NT-proBNP levels in early pregnancy were linked to a lower risk of incident hypertension 2 to 7 years after delivery (adjusted odds ratio per doubling, 0.84; 95% CI, 0.77-0.93), an association that held even after controlling for confounders like hypertensive disorders of pregnancy. Higher NT-proBNP concentrations in early pregnancy were linked to a decreased incidence of hypertensive disorders of pregnancy and hypertension 2 to 7 years after delivery in the cohort analysis. The outcomes implied that normal early-pregnancy cardiovascular physiology, as measured by NT-proBNP concentration, might provide biological insights into pregnancy outcomes and cardiovascular disease risk.