Hypertrophic cardiomyopathy (HCM) in pregnancy presents unique hemodynamic and arrhythmic challenges despite generally low maternal mortality. This JACC State-of-the-Art Review synthesizes current evidence on preconception risk stratification, genetic counseling, antepartum surveillance, arrhythmia management, and delivery and postpartum care. Key considerations include assessing left ventricular outflow tract obstruction, systolic function, and arrhythmia burden and applying CARPREG II (Cardiac Disease in Pregnancy Study II)/modified World Health Organization classifications to guide monitoring intensity. Pregnancy is typically well tolerated in low-risk women, whereas severe obstruction or systolic dysfunction confers high maternal-fetal risk. Multidisciplinary pregnancy heart team management remains essential to optimize outcomes and support informed decision making across the reproductive continuum.

Beta-blockers have long been a foundational pharmacotherapy in cardiovascular care across many disease conditions. However, the emergence of contemporary randomized trials and large population analyses has reshaped our understanding of their appropriate use. This review highlights well established indications, such as chronic heart failure with reduced ejection fraction and angina, while also examining recent studies that have questioned routine use in certain scenarios such as myocardial infarction in patients with preserved ejection fraction, stable coronary artery disease, heart failure with preserved ejection fraction, first-line antihypertensive therapy, and perioperative management. Evolving data suggest that benefits are more nuanced than previously recognized and must be individualized based on underlying pathology, ventricular function, and symptomatic burden. This article provides a practical, indication-focused framework and identifies areas where further evidence is needed to refine prescribing and deprescribing practices.