Hypertensive Pregnancy Disorders: From Mechanisms to Management

Abstract Hypertensive disorders of pregnancy (HDP) are a leading cause of maternal and perinatal morbidity and mortality globally, affecting up to 10% of pregnancies. As rates of obesity, chronic hypertension, and advanced maternal age continue to rise, the burden of HDP is expected to escalate. This review provides a comprehensive overview of HDP, encompassing updated classification systems, risk factors, and diagnostic approaches, including emerging biomarkers and predictive imaging tools. We highlight the complex pathophysiology involving impaired placentation, angiogenic imbalance, immune dysregulation, oxidative stress, mitochondrial dysfunction, and epigenetic modifications. Current management strategies are discussed alongside evolving therapeutic interventions, including low-dose aspirin, statins, and novel agents such as hydrogen sulfide donors and C-type natriuretic peptide. Special emphasis is placed on racial, ethnic, and socioeconomic disparities that contribute to disproportionate outcomes, particularly among Black and Indigenous women. We also explore the role of personalized medicine, predictive models, and digital health tools in transforming HDP care. By integrating mechanistic insight with public health strategies and clinical innovation, this review aims to inform multidisciplinary approaches to reduce the burden of HDP and promote equitable maternal and neonatal outcomes.