Lessons Learned From Treating 34 Million People With Hypertension: The Global HEARTS Initiative

Area of Science:

• Public Health
• Cardiovascular Medicine
• Health Systems Strengthening

Background:

• Hypertension is a leading cause of preventable death globally, with poor blood pressure (BP) control rates.
• The World Health Organization (WHO) HEARTS technical package offers scalable interventions for hypertension management.
• Resolve to Save Lives has supported HEARTS-based programs in 38 countries since 2017.

Purpose of the Study:

• To describe barriers and facilitators of success in multi-country HEARTS-based hypertension control programs.
• To share lessons learned from large-scale implementation of hypertension interventions.
• To identify strategies for improving BP control rates globally.

Main Methods:

• Collaboration with national governments and stakeholders to implement HEARTS programs.
• Utilizing linear drug- and dose-specific treatment protocols.
• Employing advocacy, mentoring, and digital information systems for program scale-up.

Main Results:

• Over 34 million people initiated treatment across >220,000 facilities in 38 countries by December 2024.
• Linear protocols proved effective, cost-saving, and enabled non-physician healthcare worker participation.
• Key challenges included reliable access to affordable medicines and policy/institutional barriers to task shifting.

Conclusions:

• Implementing country-developed protocols, improving drug supply chains, and investing in digital systems are critical for scaling hypertension control.
• Addressing policy and institutional barriers through advocacy, training, and supervision is essential for team-based care and task shifting.
• Strategies like eliminating user fees, decentralizing treatment, and integrating services can improve uptake, retention, and BP control, making 50% community BP control achievable.