BACKGROUND: Hypertension remains the leading risk factor for cardiovascular disease in women, and those who have a hypertensive disorder of pregnancy are at particular risk. We aimed to determine whether peripartum interventions for hypertension are associated with long-term cardiovascular risk. METHODS: In this systematic review and meta-analysis, we searched six databases-MEDLINE, Embase (via Ovid), the Cochrane Central Register of Controlled Trials, Scopus, Web of Science Core Collection, and the Cumulative Index to Nursing and Allied Health Literature-from database inception to June 18, 2025, for randomised and non-randomised studies that reported on the effect of peripartum interventions (lifestyle, pharmaceutical and nutraceutical, and remote blood pressure management) on cardiovascular outcomes of women with hypertensive disorders of pregnancy. The primary outcome measures of interest were blood pressure, cardiovascular structure and function, and development of cardiovascular disease. We performed random-effects meta-analyses of systolic and diastolic blood pressure outcomes. Other outcomes could not undergo meta-analysis due to heterogeneity of approaches and limited data. Heterogeneity was assessed using the I 2 statistic. Robustness was examined using leave-one-out sensitivity analyses, funnel plots, and Egger's test for small-study effects. GRADE was used to assess the certainty of evidence. The study is registered with PROSPERO, CRD42024581604. FINDINGS: We identified 11 251 unique records. 34 manuscripts, reporting on 32 unique studies consisting of 3558 women with hypertensive disorders of pregnancy, were included in the systematic review. Most interventions were evaluated up to 2 weeks postpartum; few studies had more than 6 weeks follow-up. 12 of 32 studies were included in the meta-analysis. Pharmaceutical and nutraceutical interventions in the antenatal and postnatal periods did not significantly affect systolic (antenatal period pooled mean difference -3·60 mm Hg [95% CI -14·25 to 7·05], p=0·51, I 2=87·7%; postnatal period -2·69 mm Hg [-5·80 to 0·41], p=0·089, I 2=70·0%) or diastolic (antenatal period -4·58 mm Hg [-11·60 to 2·44], p=0·20, I 2=87·5%; postnatal period -3·30 mm Hg [-7·07 to 0·47], p=0·087, I 2=95·1%) blood pressure up to 1 week postpartum. Remote blood pressure management was associated with significant reductions in both systolic (-8·02 mm Hg [-10·21 to -5·84], p<0·0001, I 2=3·7%) and diastolic (-6·46 mm Hg [-7·85 to -5·07], p<0·0001, I 2=0%) blood pressure within 1 year postpartum. Blood pressure data were insufficient to perform a meta-analysis on lifestyle interventions. Few studies reported on cardiovascular structure and function although improved diastolic function was consistently reported. Clinical outcomes were rarely reported, which led to small sample sizes and low statistical power. Following the GRADE assessment, there was moderate certainty on the effect of antenatal pharmaceutical and nutraceutical therapy and remote blood pressure management on postpartum blood pressure outcomes and limited confidence (low-quality evidence) supporting postnatal pharmaceutical and nutraceutical therapy. INTERPRETATION: There is a paucity of evidence around peripartum interventions and their effect on modifying cardiovascular risk through blood pressure reduction. There were no high-quality randomised controlled trials reporting long-term outcomes. Future research, with longer follow-up of cardiovascular outcomes or validated surrogate measures of cardiovascular disease, are needed to identify optimal peripartum interventions to reduce risk. FUNDING: None.