Implementing the HEARTS Initiative in Mendoza, Argentina: A multi-level, staged approach to improving hypertension...

To describe HEARTS Initiative implementation in Mendoza, Argentina, focusing on governance, adaptations, and lessons from scaling a standardized hypertension care model across the provincial public health system.

This descriptive case study analyzed HEARTS introduction and scale-up in Mendoza from 2022 to 2024. Data sources included ministerial resolutions, technical planning documents, and health system monitoring data. Implementation was examined using a five-stage framework (assess, develop, introduce, expand-early, expand-mature), analyzing actors, facilitators, barriers, and adaptations.

In 2022, Mendoza's Ministry of Health issued a provincial ministerial resolution formally designating HEARTS as the standard hypertension care model for all public health services. This enabled province-wide procurement of validated blood pressure devices, formulary revision prioritizing first-line antihypertensives, and training of nearly 4 000 health workers. HEARTS indicators were incorporated into the provincial digital information system for routine monitoring. By 2024, 36 046 adults were receiving antihypertensive medication through the provincial public system, and 12 617 adults aged 20-64 years met active follow-up criteria (at least one visit and documented medication dispensation in the previous 12 months), representing a 40% increase since 2022. These data suggest approximately 15% of the estimated 243 584 adults with hypertension relying exclusively on public services are now under documented treatment and follow-up.

Mendoza demonstrates that binding policy mandates coupled with standardized protocols, centralized procurement, unified information systems, and workforce training can institutionalize HEARTS in decentralized federal health systems. These findings are relevant for other Argentine provinces and subnational health systems in the Americas seeking to strengthen hypertension control through primary care.