Over the past two decades, research on anthropogenic underwater noise has advanced rapidly, establishing it as a recognized pressure with well-documented effects on marine mammals. There is now growing evidence for anthropogenic noise also being a pressure for fishes and invertebrates. However, most studies to date treat anthropogenic noise as an isolated pressure, despite mounting evidence that aquatic organisms experience and integrate multiple pressure simultaneously. This chapter argues that anthropogenic underwater noise must now be understood within a broader multipressure framework. Furthermore, the chapter summarizes key conceptual advances—from receptor-based approaches and the PCoD/PCoMS models to ongoing efforts under the EU Marine Strategy Framework Directive—and outline methodological priorities for integrating acoustic, chemical, and physical pressures. The need for comparative experimental design, cross-disciplinary collaboration among acousticians, ecologists, and fisheries scientists is also highlighted, as well as improved policy alignment between Europe and the United States. Finally, the aquatic noise community is called upon to embed multipressure thinking into future research and meetings, including at The Effects of Noise on Aquatic Life conferences. Moving beyond single-pressure assessments will help ensure that management frameworks reflect ecological reality—and that regulation keeps pace with how aquatic life actually experiences its environment.