A bold takeaway: hypertension is the era’s most deadly, yet most solvable, cardiovascular threat—and the HEARTS Quality Framework is our practical roadmap to counter it and save lives.
PAHO has introduced the HEARTS Quality Framework, published in The Lancet Regional Health – Americas, as a ready-to-use guide for countries to elevate hypertension and cardiovascular risk care. The goal is clear: prevent heart attacks and strokes and deliver better, closer-to-home care through strong primary health services.
In the Americas, heart disease and strokes kill more than 2.2 million people each year, with a large share of victims in their productive years. High blood pressure, often called the silent killer, is the leading risk factor, affecting nearly 40% of adults in the region. Even though affordable, effective treatments exist, only about one in three people with hypertension have it under control.
Hypertension remains both the globe’s deadliest health challenge and one of the easiest to manage with the right systems in place. Dr. Jarbas Barbosa, PAHO Director, emphasizes that this Framework isn’t just another policy paper; it’s a practical playbook already saving lives in thousands of neighborhood clinics. If nations adopt and scale it, millions more heart attacks and strokes could be prevented in the coming decade.
The HEARTS Quality Framework translates real-world experiences into a tested blueprint designed to overcome barriers that block people from receiving care. Common obstacles include outdated blood pressure machines, gaps in essential medicines, inconsistent treatment across providers, and the burden of monthly visits just to renew prescriptions.
HEARTS in the Americas represents the largest regional adaptation of WHO’s global HEARTS initiative. It is active in 33 countries, reaches nearly 10,000 primary health care facilities, and has placed more than six million people on treatment. When fully implemented, about 60% of patients reach blood pressure control—nearly double the regional average.
The framework converts proven successes into a structured model that any country can adopt and adapt. It prescribes practical steps, such as using reliable automatic blood pressure monitors, ensuring a stable supply of quality medicines at affordable prices through regional bulk purchasing, enabling multi-month prescriptions, and empowering trained nurses to adjust medications. It also recommends simple monthly monitoring tools to track performance and drive rapid improvements.
Together, these elements target the “80-80-80” objective for blood pressure control: 80% of people with hypertension diagnosed, 80% of those diagnosed treated, and 80% of those treated achieving blood pressure control. Dr. Pedro Orduñez, the corresponding author and PAHO Senior Advisor for Cardiovascular Disease, notes that reaching this target could prevent more than 400,000 deaths and 2.4 million hospitalizations by 2030 in the Americas.
Ministries of health, policymakers, and healthcare teams are urged to adopt the HEARTS Quality Framework. By committing to this model, better care for noncommunicable diseases (NCDs) can be delivered, millions of lives saved, and primary health care strengthened across the Americas.
Proven impact across the region
The HEARTS approach is already transforming how hypertension and cardiovascular risk are managed. In Matanzas, Cuba, control rates rose from 36% to 58% in one year; in Chile, from 37% to 65%, with analyses showing the program pays for itself within two years by preventing costly cardiac events. Similar gains have been observed in Colombia, Mexico, Trinidad and Tobago, and other locations after adopting HEARTS standards.
In the Dominican Republic, HEARTS is a government priority that provides free treatment to millions. El Salvador expanded HEARTS across its primary health care network, achieving control rates near 70%, and Mexico has begun large-scale nationwide implementation.
Dr. Esteban Londoño, the lead author and PAHO international consultant in noncommunicable diseases, summarizes the news: hypertension control and cardiovascular risk management at scale are indeed possible. With standardized clinical pathways, reliable medicines, team-based care, and ongoing quality improvement, HEARTS can generate life-saving impact for millions.
For more details, the policy framework—HEARTS quality: a policy framework to strengthen hypertension and cardiovascular risk management in primary healthcare—drawn from HEARTS in the Americas, is published in The Lancet Regional Health – Americas. The full article and its insights are available at the journal’s site.
