Exercise stress echocardiography revealed distinct cardiovascular dysfunction patterns in 885 midlife women who experienced pregnancy-related hypertension. Women with gestational hypertension showed 9 mmHg higher peak exercise systolic blood pressure and elevated pulse pressure compared to those with normal pregnancies. Those with preeclampsia demonstrated reduced exercise capacity, stopping treadmill tests 70 seconds earlier on average, and were referred for cardiac testing 3 years sooner after delivery. Both groups showed twice the likelihood of concentric heart remodeling and worse diastolic function parameters. These findings illuminate how pregnancy complications create measurable cardiovascular vulnerabilities that persist for years. The study strengthens growing evidence that pregnancy serves as a cardiovascular stress test, with hypertensive disorders acting as early warning signs for future heart disease. The distinct patterns—exercise intolerance in preeclampsia versus exaggerated blood pressure responses in gestational hypertension—suggest different underlying mechanisms of cardiac damage. For the estimated 10-15% of women experiencing these pregnancy complications, this research supports more aggressive cardiovascular screening in midlife. However, as an unreviewed preprint, these findings require peer validation before influencing clinical practice guidelines for post-pregnancy cardiac monitoring.