Guideline reviewers: Claudio Borghi (Italy), Fadi Charchar (Malaysia), Alfred Doku (Ghana), Maria Dorobantu (Romania), Joseph Flynn (USA), Nadia Khan (Canada), Anastasios Kollias (Greece), Reinhold Kreutz (Germany), Azra Mahmud (Pakistan), Giuseppe Mancia (Italy), Gianfranco Parati (Italy), Neil Poulter (UK), Jane Reckelhoff (USA), Nicolas Renna (Argentina), Abdulla Shehab (UAE), Markus Schlaich (Australia), Aletta Schutte (Australia), Boon Wee Teo (Singapore), Maciej Tomaszewski (UK), Rhian Touyz (Canada), Jiguang Wang (China), Thomas Weber (Austria), Paul Whelton (USA) and Yuqing Zhang (China).

Validated blood pressure (BP) monitors are essential for the accurate diagnosis and management of hypertension. In 2018, the Association for the Advancement of Medical Instrumentation (AAMI), the European Society of Hypertension (ESH), and the International Organization for Standardization (ISO) introduced the AAMI/ESH/ISO Universal Standard (ISO 81060-2:2018) to establish globally accepted requirements for validation studies. This standard is developed specifically for cuff BP devices and is inadequate for cuffless ones, which require different validation procedures. In 2018, the ESH Working Group on Blood Pressure Monitoring published a practical guide and checklist for performing and reporting validation studies of cuff BP devices. Thereafter, two recent amendments (1:2020 and 2:2024) introduced additional requirements for limb and cuff size distribution to ensure that the entire limb range per cuff is adequately assessed. Despite these major initiatives, regular reviews of published validation studies performed by STRIDE BP have identified persistent violations of the validation requirements and incomplete reporting of important data. This statement, prepared by STRIDE BP and the ESH Working Group on Blood Pressure Monitoring, provides an updated guide and checklists, which are complementary to our 2019 guide and aim at assisting investigators and reviewers in performing and reporting high-quality validation studies of cuff BP devices that comply with the latest requirements by the AAMI/ESH/ISO Universal Standard.

In nondialysis chronic kidney disease (CKD) patients, masked hypertension (MH), white-coat hypertension (WCH), nondipping, and nocturnal hypertension phenotypes are known to complicate the diagnostic and therapeutic approach, but their prevalence remains unclear. A systematic search of two databases (PubMed, EmBase) from inception through October 1, 2025 was performed to identify records reporting MH, WCH, nocturnal hypertension, and nondipping prevalence in this population. A meta-analysis (REML model) was conducted to calculate respective pooled prevalences. From 2355 records screened, 68 were selected including 41 989 patients. Meta-analysis of 33 studies (n = 26 539, weighted mean age 60.9 years, 58% males, mean eGFR 49.3 ml/min) indicated 11% pooled WCH prevalence [95% confidence interval (CI) (8, 14%)]. Further analyses (33 studies, n = 26 542) indicated pooled MH prevalence 23% (19, 27%), pooled nondipping and dipping prevalence 66% (61, 70%) and 34% (30, 39%), respectively (49 studies, n = 22 773 - two phenotype analysis) and pooled dipping, nondipping, extreme dipping and reverse dipping pooled prevalence 28% (24, 33%), 43% (40, 46%), 3% (2, 6%), 23% (18, 27%) respectively (20 studies, n = 10 865 - four phenotype analysis). Meta-analysis of 14 studies (n = 15 701) indicated nocturnal hypertension prevalence 57% (47, 67%). Ambulatory and home blood pressure monitoring were equivalent in detecting WCH and MH (P = 0.68/0.4, respectively). Glomerular filtration rate was not associated with the MH/WCH prevalence. Nondialysis CKD patients experience an important burden of MH, nocturnal hypertension and nondipping, and lesser WCH. These results strongly support the necessity for out-of-office blood pressure evaluation in these patients.

Hypertensive disorders of pregnancy (HDP) remain a leading cause of maternal and perinatal morbidity and mortality worldwide, especially in low- and middle-income countries. Moreover, HDP are directly linked to an increased risk of long-term cardiometabolic and kidney disease in mothers and offspring. Since prevention, diagnosis, and treatment of HDP remain suboptimal globally, enhanced understanding and implementation of current guidelines on HDP present a substantial opportunity to significantly reduce maternal and fetal morbidity and mortality. This position paper by the International Society of Hypertension reviews current knowledge in the field, identifies knowledge gaps and provides recommendations on the care of women with HDP and lifelong care, thereafter.

Wearable wristwatch-type cuff oscillometric blood pressure (BP) monitors represent a new category of BP devices and are the first wearable monitors to use established cuff-oscillometric BP measurement technology. This consensus statement by the European Society of Hypertension Working Group on BP Monitoring reviews the published evidence on their design, accuracy, validation, clinical application, and remaining research questions. Of 281 articles identified through a systematic PubMed search, 26 were relevant. Several devices are currently available; however, only two have published validation studies performed according to established standards (Omron HeartGuide and Huawei Watch D/D2). Static validation studies generally showed acceptable accuracy, whereas data on 24-h ambulatory use, in special populations, and clinical applications remain limited. Potential advantages include self-initiated measurement at home, at work, and in other settings and conditions; more convenient and repeatable 24-h ambulatory monitoring; more convenient and accurate assessment of asleep BP; capture of stress-related and other BP-related episodes. However, proper wrist position, user adherence, ambulatory performance, and clinical applications require further investigation. More research is needed to establish the accuracy and clinical utility of these novel devices and their role in improving the diagnosis and management of hypertension.

Hypertension in sub-Saharan Africa is escalating, with many cases undiagnosed and poorly controlled, even among children, despite its significant contribution to cardiovascular disease. Poor blood pressure control is largely due to limited national guidelines, underfunded programs, and a shortage of trained health professionals. Simplified protocols for non-physician health workers, who deliver most of the primary care, are essential. Cultural myths and misconceptions further delay care, underscoring the need for community-based education. Early and opportunistic screening, including in schools, markets, and places of worship, is vital across the life course. Sustainable progress depends on tailored strategies, investment in equipment and training, and leveraging existing infrastructure to improve hypertension detection and management. Africa-centred hypertension guidelines are now a priority because international models fail to address the continent's unique clinical, cultural and resource realities. The African Regional Advisory Group of the International Society of Hypertension worked with the Pan African Society of Cardiology to develop simplified protocols for primary care, particularly for non-physician health care workers, by considering the special situation and condition for managing the vast majority of cases within hypertension in Africa.