Hypertension control on a national scale is possible, according to an initiative that identifies treatment protocols, reliable medication supply, team-based care and strong digital systems to dramatically raise control rates. The Global HEARTS Initiative, which gathered data from 34 million people on treatment at >220,000 primary care facilities across 38 countries, also found that the biggest threats to achieving high blood pressure control were not clinical limitations, but system failures. These were gaps in medicine availability, delays in treatment intensification and inconsistent BP measurement practices that, according to the researchers, undermined progress, even in programs with strong clinical protocols and trained staff. Affordable medication “Despite the abundance of generic antihypertensive medicine manufacturers globally, reliable and affordable medication supply remains the biggest barrier to hypertension treatment at scale and BP control in many low- and middle-income countries (LMICs),” said the authors of the paper, led by Bolanle F. Banigbe, MBBS, from Resolve to Save Lives in New York. “Most LMICs do not spend sufficiently or efficiently on antihypertensive medicines, rely on past consumption data to forecast, and have fragmented drug selection procedures.” The new report, published in the Journal of the American College of Cardiology, also discovered that where treatment protocols were followed, countries found inconsistences in adherence among providers and delays in dose escalation, issues that reduced control rates. Closing treatment gaps The report also highlighted that tackling therapeutic inertia needed continuous mentoring, clearer task-sharing policies, and routine performance evaluations to close gaps between recommended care and actual practice. “Implementing country-developed protocols improves uptake; countries needed to use advocacy and mentoring to shift provider behaviors and policy barriers hindering full implementation,” said the paper’s authors. “Although treatment can cost <$5 per patient per year, reliable access to affordable, quality-assured medicines is often a critical bottleneck to program scale-up.” The research team added that strategies to improve drug supply were context specific and included morbidity-based forecasting and advocacy to increase funding and include protocol medicines in national essential medicines lists. Digital systems One such enabler of improvement was a digital system that integrated mobile-first, offline-capable tools that could identify patients who missed visits, track medication stock in real time and monitor blood pressure trends across entire districts. According to the researchers, these systems generated accountability loops that had proved impossible in the past with paper-based records. “An effective digital system that provides real-time information to improve patient management and program performance is critical to scale HEARTS programs,” said the paper’s authors. “User-centered, off-line-first digital information systems, and focus on critical metrics, particularly BP control rate, facilitate steady progress.” Patient burdens The report also emphasized how crucial it was to reduce the patient burden of long-term care with initiatives that reduced out-of-pocket costs, extended refill durations and decentralized services to community-level clinics. While these initiatives achieved markedly higher retention and better blood pressure outcomes, the team also highlighted how service design, not just clinical quality, shaped whether patients remained engaged in treatment. “Achieving 50% community BP control is within reach if global organizations and national health programs prioritize implementing the World Health Organization HEARTS program,” the report concluded. Source: Banigbe BF, Moran AE, Gupta R, et al. Lessons Learned From Treating 34 Million People With Hypertension: The Global HEARTS Initiative. J Am Coll Cardiol. 2025;86:2374–2387. Image Credit: anatoliycherkas – stock.adobe.com