The rate of new-onset hypertensive disorders of pregnancy (HDP) in the U.S. increased significantly from 2016 to 2024 across all racial and ethnic groups, according to a brief JACC report – the importance of which is further echoed in a longer systematic review of blood pressure (BP) monitoring across a patient's lifespan published in JACC's May 12 hypertension focus issue.

Study authors Emily Lam, BA; Sadiya S. Khan, MD, FACC; and Nilay S. Shah, MD, FACC; used data from the National Center for Health Statistics to identify 12 million pregnant women aged 15-44 without pre-pregnancy hypertension with a first singleton live birth from Jan. 2016 to Dec. 2024. Their mean age at delivery was 27.1 years.

Results showed that the HDP rate increased by 6.7% per year, from 81.3 per 1,000 live births in 2016 to 136.8 per 1,000 live births in 2024. This was a significant increase across all primary racial and ethnic groups, with HDP rates highest among American Indian or Alaska Native women (2024 rate: 196.6 per 1,000 live births) and lowest among Asian women (82.1 per 1,000 live births), although Asian women encountered the fastest rate of increase across the study period.

"Given the associations of HDP with future [cardiovascular health], these patterns portend worsening long-term risk of cardiovascular disease risk in women," write the authors. "To support pre-pregnancy health to prevent HDP and optimize the care of patients with HDP, multilevel efforts at the clinical, health system, and health policy levels are needed."

The often-limited accuracy of BP monitoring data and other HDP challenges faced by pregnant women is just one of the areas of focus in the JACC systematic review, where Marwah Abdalla, MD, MPH, FACC, et al., summarize the findings of a December 2024 workshop on BP assessment hosted by the National Heart, Lung, and Blood Institute. The report synthesizes evidence showing that inaccurate and inconsistent BP measurement across the lifespan remains a major barrier to hypertension diagnosis, management and risk reduction, and outlines priorities to improve assessment through standardized techniques, expanded use of out-of-office monitoring, and integration of emerging technologies, including artificial intelligence (AI) and wearable devices.

In its evaluation of 14 research priorities outlined in a prior 2017 workshop, the report identifies persistent measurement challenges, including technique errors like cuff size and positioning, observer and documentation bias, physiologic and environmental conditions, and lifespan-specific issues, such as the limited availability of validated devices and frequent cuff-size mismatch in children or gaps in the understanding of HDP in women, especially into the postpartum period.

The report also identifies promising areas of future focus, especially surrounding out-of-office ambulatory blood pressure monitoring (ABPM) and self-monitored blood pressure (SMBP), emerging technologies such as cuffless devices and other wearables, and AI systems for data synthesis, pattern recognition and workflow support.

It ends with a roadmap of short-term and long-term priorities, including expanding use of guideline-supported ABPM and structured SMBP, strengthening device validation standards, improving electronic health record integration and interoperability, and addressing reimbursement and workflow barriers to real-world adoption.

"Realizing the full potential of novel BP technologies requires coordinated cross-sector efforts in research, regulation, implementation science and workforce training to deliver accurate, practical and accessible BP-assessment tools that support timely and effective diagnosis and management of hypertension for all populations," write the review authors.

"BP measurement is entering a new phase defined by precision, integration and collaboration," writes Yuan Lu, ScD, FACC, in an accompanying editor's note. "The next step is to translate this framework into practice. If successful, these efforts will improve the accuracy of BP measurement, reinforce the foundation of hypertension care and advance progress toward reducing preventable cardiovascular disease."