Evidence-informed prioritization of interventions for integrating hypertension management into cardiovascular-kidney-metabolic care in primary health care: HEARTS 2.0 Phase 3
Year: 2026
Type: article
Abstract: BACKGROUND: HEARTS in the Americas is the regional adaptation of the WHO Global HEARTS Initiative. This paper presents Phase 3 of HEARTS 2.0, an evidence-informed process to prioritize clinical and health-system interventions to support the operationalization of integrated cardiovascular, kidney, and metabolic (CKM) care in primary health care (PHC) and to inform the update of the HEARTS Clinical Pathway. CKM conditions frequently coexist, sharing common risk factors and pathophysiological mechanisms that exacerbate cardiovascular disease burden. Despite their overlap, clinical practice often remains siloed due to condition-specific guidelines, and its integration remains limited. To prioritize evidence-informed clinical and health-system interventions that support the operationalization of integrated CKM care within PHC and inform the update of the HEARTS Clinical Pathway. METHODS: Building on previous phases of HEARTS 2.0, a multidisciplinary panel evaluated 45 candidate interventions in different areas. The selection process utilized structured evidence appraisal, Evidence-to-Decision frameworks, and a modified RAND/UCLA appropriateness method involving anonymized rating rounds. RESULTS: A total of 38 interventions were prioritized for implementation. Although hypertension management remains the primary entry point, the resulting framework integrates early detection of diabetes and chronic kidney disease, lifestyle interventions, risk-based combination pharmacotherapy, task-sharing, and longitudinal follow-up. CONCLUSIONS: By translating dispersed guideline recommendations into implementable interventions, Phase 3 of HEARTS 2.0 provides an evidence-informed basis for advancing integrated CKM care at scale in PHC and guiding the forthcoming update of the HEARTS Clinical Pathway. The resulting framework offers a flexible, scalable approach for countries confronting similar epidemiological and health system challenges.
Source: American Journal of Hypertension
DOI: 10.1093/ajh/hpag033
Authors: Pedro Ordunez, Andres Rosende, Maria Florencia Grande Ratti, Donald J DiPette, Ana Marcela Torres, Esteban Londoño, Sonia Y Angell, Mariana L Rodriguez de la Cerda, Norm R C Campbell, Libardo Rodríguez Martínez, Jeffrey Brettler, Fernando Tortosa, Vilma Irazola, Marc G Jaffe, Ariel Izcovich, Niamh Chapman, Andelys de la Rosa, Ana Claudia de Souza, Miguel Angel Diaz Aguilera, Paula Diaz Valencia, David Flood, Lourdes Jarquin, Taskeen Khan, Javier Mariani, Andrew E Moran, Carolina Neira Ojeda, Emily Ridley, Marcela Rivera, Gonzalo Rodriguez, Cesar A Romero, Santiago Torroba, Yamile Valdes Gonzalez, Natalia Vensentini, Irmgardt A Wellmann, Eric Zuniga, Ludovic Reveiz, Paul K Whelton
Institutions: World Health Organization Regional Office for the Americas, University of South Carolina, Johns Hopkins University, Columbia University Irving Medical Center, Columbia University, University of Calgary, Kaiser Permanente, Kaiser Permanente Bernard J. Tyson School of Medicine, Instituto de Efectividad Clínica y Sanitaria, The University of Sydney, Hospital Moinhos de Vento, Universidad de Antioquia, University of Michigan, Ministerio de Salud, Qatar Foundation, Hospital El Cruce, Resolve to Save Lives, Ministry of Health, Prisma Health, Fundacion Favaloro Hospital Universitario, Favaloro Foundation, Emory University, Ministerio de Salud Pública, Ministerio de Salud, Institute of Nutrition of Central America and Panama, Universidad de Antofagasta, Tulane University
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,814
Award: G5070971123
OpenAlex ID: W7155364102