PROJECT SUMMARY Cardiovascular disease (CVD) is the leading cause of death among women in the United States. Women who experience hypertensive disorders in pregnancy (HDP), including chronic hypertension, gestational hypertension, and pre-eclampsia/eclampsia, are at substantially higher future CVD risk. Although increased risk of CVD after pre-eclampsia was identified in the 1960s, little attention has been paid to whether women with HDP receive appropriate care accounting for the increased CVD risk. Maternity and postpartum care offer critical points of access to the health care system, especially for low-income and underinsured women who gain insurance coverage during pregnancy and childbirth. Women with HDP require ongoing management of CVD risk across the lifecourse, and the postpartum period is a unique window of opportunity to engage women in primary care to improve outcomes. Despite low rates of postpartum transition to primary care for CVD risk management for women with HDP, little is known about the impact of patient and system factors on this transition. We use a mixed methods approach to examine patient, insurance, clinician, and organizational characteristics influencing the postpartum transition to primary care for women with HDP. The specific aims are: 1) to determine the role of patient and insurance characteristics in the postpartum primary care transition for women with HDP; 2) to determine the role of clinician and organizational characteristics in the postpartum primary care transition for women with HDP; and 3) to explore the process of transition from obstetric care to primary care in the postpartum year from the perspectives of women with HDP and clinicians Efforts are ongoing to incorporate pregnancy risk factors into existing CVD risk calculators and to develop guidelines for care specific to women with a history of HDP. However, for primary care guidelines to be successful in improving the health of women at high risk for CVD, we must first ensure that the transition to primary care occurs in the postpartum period. Findings from this study will provide essential information to guide future improvements in the postpartum care transition for women with HDP by contributing to the identification of process improvements and policy levers that will improve the quality of care and clinical practice.