PROJECT SUMMARY Cardiovascular disease (CVD) is the leading cause of death among women in the United States, and Black women have higher rates of CVD mortality than White women. Women who experience hypertensive disorders in pregnancy (HDP), including chronic hypertension, gestational hypertension, and pre-eclampsia/eclampsia, face substantially higher future CVD risk. About one in seven women experience HDP by the end of their childbearing years, with higher rates among women of color. HDP is an important sex-specific risk-enhancer for CVD as a history of HDP imparts a similar increase in CVD risk as smoking cigarettes or having a family history of CVD. Transitioning to primary care postpartum is recommended for all women but has particular urgency for women with HDP. Primary care is an appropriate setting for short- and long-term CVD risk management, including identification and treatment of hypertension and hyperlipidemia. However, little is known about the primary care provided for postpartum women with HDP and whether it responds to their heightened CVD risk. Prior research has shown substantial disparities in rates of postpartum primary care use by insurance status and by race/ethnicity, and in the care delivered immediately postpartum, but little is known about clinical care delivered in postpartum primary care after experiencing HDP for CVD risk management and whether women of color and publicly insured women receive different care. Our parent grant (NHLBI R01HL164489-02) uses a mixed methods design to examine the postpartum transition to primary care and the CVD risk management provided within primary care for women with recent HDP. This administrative supplement will allow us to enhance our ongoing research with additional detail on intersectional patient-level factors to examine whether these systems of care disproportionately contribute to disadvantage for women of color and women with lower incomes. In response to NOT-OD-24-032, we propose to enhance Aim 2 of our parent grant by using a clinical records database to (2A) examine the association of clinician patient panel characteristics (minority-serving, Medicaid-serving) and CVD risk management in postpartum primary care, and (2B) to determine whether associations in 2A vary by individual patient characteristics (race/ethnicity, insurance type). This proposed supplement addresses how inequities in healthcare may contribute to poor CVD outcomes for women with multiple marginalized identities. Our research team will include both early career and independent investigators with appropriate expertise in maternal and women’s health, health inequities among minoritized groups, and clinical care responsive to heightened CVD risk. The proposed supplement research is important because as rates of HDP rise nationally and racial disparities in HDP persist, appropriate management of CVD risk may mitigate impact on future CVD outcomes, including premature mortality.