The HEARTS Quality Framework in The Lancet outlines strategies to improve cardiovascular care in the Americas and could prevent 400,000 deaths by 2030
Washington, D.C., 15 December 2025 (PAHO) — The Pan American Health Organization (PAHO) has launched the new HEARTS Quality Framework, a practical guide published in The Lancet Regional Health – Americas, which countries can immediately use to enhance hypertension and cardiovascular risk management, prevent heart attacks and strokes, and deliver better care through primary health care within their communities.
In the Americas, heart disease and strokes claim more than 2.2 million lives each year, and many of the victims are people in their most productive years. High blood pressure—known as the "silent killer"—is the leading risk factor, affecting nearly four in ten adults across the region. Despite the availability of affordable and effective treatments, only one in three people with hypertension have their condition under control.
“Hypertension remains the world’s deadliest health threat, but also one of the most manageable,” said Dr. Jarbas Barbosa, Director of PAHO. "This framework is not just another policy document—it's the playbook already saving lives in thousands of community health clinics. If countries adopt and scale it up, we can prevent millions of heart attacks and strokes over the next decade."
The new HEARTS Quality Framework translates real-world experiences into a tested blueprint for overcoming barriers that keep millions from getting the care they need. These include inaccurate blood pressure measurements due to outdated equipment, limited availability of essential medicines, suboptimal treatments, and unnecessary monthly visits to renew prescriptions.
HEARTS in the Americas is the world's most extensive adaptation of the World Health Organization's (WHO) global HEARTS initiative and is now active in 33 countries, reaching nearly 10,000 primary care facilities, with more than six million people managed through standardized treatment protocols. Where fully implemented, six in ten patients achieve blood pressure control — almost double the regional average.
This framework turns these proven successes into a structured model that any country can adopt and tailor to its needs. It lays out concrete strategies, such as mandating the use of reliable, automated blood pressure monitors; ensuring a steady supply of quality medicines at affordable prices through pooled procurement; enabling multi-month prescriptions; and empowering trained nurses to adjust medication doses. It also proposes simple monthly monitoring tools so that healthcare providers can track patient outcomes and make necessary adjustments to care.
Combined, these strategies support the “80-80-80 target” for blood pressure control: 80% of people with hypertension are diagnosed, 80% of those diagnosed are treated, and 80% of those treated are achieving blood pressure control. “Reaching this goal could prevent more than 400,000 deaths and 2.4 million hospitalizations by 2030 in the Americas,” explained Dr Pedro Orduñez, the corresponding author and PAHO Senior Advisor for Cardiovascular Disease.
“We urge ministries of health, policymakers, and health-care providers to adopt the HEARTS Quality Framework,” said Dr Anselm Hennis, Director of the Department of Noncommunicable Diseases and Mental Health at PAHO. “By committing to this model, we can deliver better care for noncommunicable diseases (NCDs), save millions of lives, and strengthen primary health care across the Americas.”
Proven results across the Region
The HEARTS approach is already transforming hypertension and cardiovascular risk care. In Matanzas, Cuba, control rates rose from 36% to 58% in one year, while in Chile, hypertension control increased from 37% to 65%. Further analyses highlighted the economic return on investment, with the program paying for itself in less than two years by preventing expensive cardiac events. Communities in Colombia, Mexico, Trinidad and Tobago, and other countries have similarly achieved increased blood pressure control rates after adopting the HEARTS standards of care.
In the Dominican Republic, HEARTS is a government priority, providing free treatment to millions. El Salvador expanded HEARTS across its primary health care network, achieving control rates of nearly 70%, and Mexico has also initiated program implementation nationwide.
“These results show that hypertension control and cardiovascular risk management at scale are possible,” said Dr. Esteban Londoño, lead author and PAHO international consultant in noncommunicable diseases. “Primary health care based on standardized clinical pathways, reliable medicines, team-based care, and quality-improvement tools, can generate a life-saving impact for millions.”
Links
HEARTS Quality: a policy framework to strengthen hypertension and cardiovascular risk management in primary healthcare
HEARTS in the Americas
Better Care for NCDs Initiative
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