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The discordant co-twin design offers unique strengths not afforded by other approaches primarily because relatedness and shared origins naturally match twin pairs more closely on genetic and early environmental confounders. We aimed to confirm HT-associated factors across the lifecourse among 202 female twin pairs identified from the California Twin Program (CTP) registry. A baseline questionnaire queried current and past risk factors and self-reported prevalent HT. Hypertension-discordant pairs were compared for differences in demographics, growth and body size, reproductive factors, and lifestyle factors. Data were analyzed using conditional logistic regression restricted to nonsmokers and stratified by zygosity. Weighing \u2265150lbs. versus &amp;lt;130lbs. at 18\u00a0years was associated with 3-fold odds of HT, and weighing \u2265180lbs. at the time of questionnaire was associated with 6-fold odds of HT. Exercising more than one\u2019s co-twin was associated with 0.54-fold odds of HT. Menopause was positively associated with HT, with postmenopausal DZ twins experiencing 4-fold odds of HT compared to premenopausal co-twins. This study with minimal bias using unaffected co-twins confirmed multiple factors associated with female HT including overweight at age 18 and in adulthood, lower level of exercise, and menopausal.<\/jats:p>","DOI":"10.1093\/aje\/kwag001","type":"journal-article","created":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T09:15:56Z","timestamp":1768295756000},"page":"1944-1961","source":"Crossref","is-referenced-by-count":0,"title":["Female-specific hypertension risk factors across the lifecourse: a co-twin control analysis using the California Twin Program"],"prefix":"10.1093","volume":"195","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3919-2372","authenticated-orcid":false,"given":"Kellie R","family":"Imm","sequence":"first","affiliation":[{"name":"Department of Population and Public Health Sciences, Keck School of Medicine of USC, University of Southern California , Los Angeles, CA ,","place":["United 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