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OBJECTIVE: To investigate whether genetic predisposition to pre-eclampsia (PE), measured by a polygenic risk score (PRS), is associated with incident hypertension and cardiovascular disease (CVD) after delivery in Asian women.DESIGN: Prospective population-based cohort study.SETTING: Data were utilised from the Korean Genome and Epidemiology Study and additional multicentre cohorts.POPULATION: 35 872 parous Korean women aged 40-80 years at last surveillance, with genotype data, no history of hypertension or CVD before delivery, and complete clinical information. For external validation, 559 parous Korean women were included.METHODS: The PE-PRS was calculated for Asian women, and the study population was divided into the high PE-PRS and low PE-PRS groups. The long-term risks of incident hypertension and CVD (ischaemic heart disease or stroke) after delivery were compared between the groups.MAIN OUTCOME MEASURES: Incident hypertension and CVD after delivery.RESULTS: Women in the high PE-PRS group had an increased risk of developing hypertension (adjusted hazard ratio [aHR] 1.25, 95% CI 1.17-1.34) and ischaemic heart disease (aHR 1.28, 95% CI 1.07-1.54) compared to the low PE-PRS group. The risk of hypertension was highest among women with both a history of PE and a high PE-PRS.CONCLUSIONS: Genetic predisposition to PE, as measured by the PE-PRS, is associated with an elevated risk of incident hypertension and ischaemic heart disease in Asian women. These findings suggest the potential utility of the PE-PRS as a complementary tool in assessing individualised hypertension risk in parous women.