PAHO Launches HEARTS Framework to Enhance Hypertension Care

The Pan American Health Organization (PAHO) introduces a new quality framework aimed at strengthening the prevention and management of hypertension and cardiovascular risk across the Americas, translating years of regional experience into a model that countries can implement immediately through primary health care.

Published in The Lancet Regional Health — Americas, the HEARTS Quality Framework responds to the scale of cardiovascular disease in the region, where heart disease and strokes cause more than 2.2 million deaths each year. A significant share of those deaths occurs among people of working age. High blood pressure remains the leading risk factor, affecting close to 40% of adults, yet only about one in three people with hypertension has their condition under control despite the availability of effective and affordable treatments.

Hypertension is both the world’s deadliest and one of its most manageable health threats, says Jarbas Barbosa, Director, PAHO. He adds that the new framework builds on practical solutions already being applied in thousands of primary care clinics and is designed to be scaled nationally to prevent heart attacks and strokes over the coming decade.

The framework consolidates lessons learned from the HEARTS in the Americas initiative, the largest global adaptation of the WHO’s HEARTS program. Since its launch, the initiative has expanded to 33 countries, reaching nearly 10,000 primary health care facilities and placing over 6 million people on treatment. In settings where HEARTS has been fully implemented, about 60% of patients achieve blood pressure control, nearly double the regional average.

According to PAHO, persistent gaps in hypertension care are often linked to operational barriers rather than clinical knowledge. These include inaccurate blood pressure measurements due to outdated devices, interruptions in the supply of essential medicines, inconsistent treatment approaches among providers, and the requirement for frequent clinic visits solely to renew prescriptions. The HEARTS Quality Framework addresses these challenges by offering a structured approach grounded in real-world practice.

Key strategies outlined in the framework include the use of validated automatic blood pressure monitors, regional pooled purchasing to secure a stable supply of quality medicines at lower cost, multi-month prescriptions to reduce unnecessary visits, and expanded roles for trained nurses to adjust medication dosages. It also promotes simple, routine monitoring tools that allow clinics to track outcomes and make timely improvements.

Together, these measures are designed to support the “80-80-80” target for blood pressure control: diagnosing 80% of people with hypertension, treating 80% of those diagnosed, and achieving control in 80% of those treated. Reaching this target could prevent more than 400,000 deaths and 2.4 million hospitalizations in the Americas by 2030, says Pedro Orduñez, Senior Advisor for Cardiovascular Disease, PAHO.

Regional experience cited in the study shows consistent improvements following adoption of HEARTS standards. In Matanzas, Cuba, hypertension control rates increased from 36% to 58% within a year. Chile reported an increase from 37% to 65%, with economic analyses indicating that the program offsets its costs in less than two years by avoiding expensive cardiovascular events. Similar gains have been documented in Mexico, Colombia, Trinidad and Tobago, and other countries.

Several governments have integrated HEARTS into national policy. The Dominican Republic has prioritized the program to provide free hypertension treatment at scale, while El Salvador expanded HEARTS across its primary care network and achieved control rates approaching 70%. Mexico has also begun large-scale nationwide implementation.

Adoption of the framework offers an opportunity to strengthen primary health care while improving outcomes for noncommunicable diseases, says Anselm Hennis, Director of the  Department of Noncommunicable Diseases and Mental Health, PAHO. Esteban Londoño, Consultant, PAHO, adds that standardized clinical pathways, reliable medicines, and team-based care have demonstrated that large-scale hypertension control is achievable.