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CLINICAL STATEMENTS AND GUIDELINES Circulation. 2025;152:e114–e218. DOI: 10.1161/CIR.0000000000001356 September 16, 2025 e171 5 The implementation of HIT improves hypertension control and adherence to guidelines using clinical decision support pathways.15,17 Hypertension con trol to lower home BP targets (<135/85 mm Hg) has shown to be greater after intervention via selfmonitoring and telemonitoring (HBPM or ABPM, Section 3.1.3, “Out-of-Office BP Monitoring”) compared with standard office-based care.14–16 Self-monitoring is recommended for the ongoing management of hypertension in all patients willing to use it, and clinicians should consider readings obtained from self-monitoring in titrating medica tions and ruling out white-coat hypertension and masked hypertension.48 In an RCT, SBP was lower in both self-monitoring and telemonitoring intervention groups compared with usual care with no difference between the self-monitoring and telemonitoring groups. Enhanced self-monitoring of BP paired with an advanced application was not shown to be superior to standard self-monitoring in BP control.16 Further, additional medications were prescribed to individuals using self-monitoring or telemonitoring in the titration of antihypertensive medications.14 6 Health systems are developing and using patient registries and EHRs for large-scale queries to sup port population health management strategies by identifying undiagnosed or uncontrolled hyperten sion as ongoing quality improvement initiatives.17 Multifaceted approaches studied to date include: 1) application of hypertension screening algorithms to EHR databases to identify at-risk patients; 2) contacting at-risk patients to schedule BP mea surements; 3) monthly feedback to clinicians about at-risk patients who have yet to complete a BP measurement; and 4) electronic prompts for BP measurements whenever at-risk patients visit the clinic. The role of the EHR is paramount in support ing interventions in primary care and to maximize hypertension management in under-represented racial and ethnic groups. Some clinical interven tions implementing clinical decision support sys tems and best practice alert applications in primary care clinics show promising results.15 7 RCTs and meta-analyses of RCTs of telehealth inter ventions demonstrate greater office SBP and DBP reductions18–26,65 and a larger proportion of patients achieving hypertension control compared with indi viduals receiving usual clinic-based care without telehealth interventions, but results are mixed on improving medication adherence.19–21,23–26,42,46,47 Telehealth interventions, including out-of-office BP monitoring using HBPM (Section 3.1.4, “ABPM and HBPM”) with remote BP data transfer between the patient and health care staff, lifestyle educa tion, and/or medication management, demonstrated greater BP lowering compared with usual clinic care alone.19,22,48,66 Trial results are inconsistent for inter ventions solely using mobile apps, but a growing num ber of studies demonstrate significant BP reduction based on strengthening patients’ self-management skills.46,67,68 Limited telehealth RCTs have focused on under-represented racial and ethnic populations, with some demonstrating reduced BP among Black and Hispanic populations.25,46 Hypertension telehealth interventions demonstrated significant BP reduction in patients with comorbid conditions (eg, diabetes, stroke); however, there are insufficient data on reduc tion of MACE.46 Even as there is increasing use of hypertension telehealth interventions, significant bar riers remain for equitable access to telehealth ser vices, including patient internet access, digital literacy, equipment/infrastructure costs, clinical staffing/ workflow, and integration with EHRs.46,47 Additional studies are needed, particularly among high-risk underrepresented racial and ethnic populations.46,47,69 5.5 Hypertension and Pregnancy Recommendations for Individuals With Hypertension and Pregnancy* Referenced studies that support the recommendations are summarized in the Evidence Table. COR LOE Recommendations 1 A 1 For individuals with hypertension who are planning a pregnancy or who become pregnant, labetalol and extended-release nifedipine are preferred agents to treat hypertension and minimize fetal risk.1 1 B-R 2 Individuals with hypertension who are planning a pregnancy or who become pregnant should be counseled about the benefits of low-dose (81 mg/day) aspirin to reduce the risk of preeclampsia and its sequelae.2 1 B-R 3 Pregnant individuals with SBP ≥160 mm Hg or DBP ≥110 mm Hg confirmed on repeat measure ment within 15 minutes should receive antihy pertensive medication (Table 23) to lower BP to <160/<110 mm Hg within 30 to 60 minutes to prevent adverse events.3–7 1 B-R 4 Pregnant individuals with chronic† hypertension (defined as prepregnancy hypertension or SBP 140 to 159 mm Hg and/or DBP 90 to 109 mm Hg prior to 20 weeks’ gestation) should receive antihypertensive therapy to achieve BP <140/90 mm Hg to prevent maternal and perinatal morbidity and mortality.1,8,9 3: Harm C-LD 5 Individuals with hypertension who are planning a pregnancy or who become pregnant should not be treated with atenolol, ACEi, ARB, direct renin inhibi tors, nitroprusside, or MRA to avoid fetal harm.10–14 *ACOG diagnostic criteria and classification of hypertensive disorders of preg nancy are found in Tables 22 and 23. †Chronic hypertension in pregnancy is defined as a preexisting diagnosis of hypertension or SBP ≥140 mm Hg and/or DBP ≥90 mm Hg on 2 occasions at least 4 hours apart before 20 weeks’ gestation. Synopsis HDP are strongly associated with maternal and fe tal/neonatal complications and are a leading cause of Downloaded from http://ahajournals.org by on October 7, 2026