WHO HEARTS Programs in High-Income Countries: Implementation, Outcomes, and Implications for Global Hypertension Control

Despite advanced healthcare systems and near-universal coverage, hypertension control rates have stagnated in many high-income countries (HICs), even as this condition remains the leading preventable cause of cardiovascular disease and premature mortality worldwide. The WHO HEARTS technical package, initially designed for low- and middle-income countries (LMICs), offers a comprehensive framework for strengthening hypertension management through six core components: healthy lifestyle counseling, evidence-based protocols, access to essential medicines and technology, risk-based cardiovascular disease management, team-based care, and systems for monitoring. Modeled on prior global analyses of WHO HEARTS in LMICs, this structured program report synthesizes available evidence on HEARTS implementation and outcomes in HICs, drawing on national registry data, PAHO/WHO program reports, and pooled epidemiological surveys. Results demonstrate that HEARTS is both feasible and effective in high-resource settings, with early adopters achieving substantial improvements in hypertension control. This report also identifies key barriers to HEARTS implementation in HICs, including therapeutic inertia, physician resistance to standardized protocols, fragmented electronic health record systems, and persistent socioeconomic inequities. However, HICs possess distinct advantages including advanced monitoring infrastructure, trained multidisciplinary teams, reliable medication supply chains, and financing capacity. These findings demonstrate that HEARTS provides a relevant and necessary framework for HICs to overcome systemic barriers, close equity gaps, and achieve sustained improvements in hypertension control. Expanding HEARTS across high-resource settings represents a critical opportunity to reverse declining control trends and prevent avoidable cardiovascular disease globally. Figure. Global Implementation of HEARTS: HICs, LMICs, Reference Models, and Benchmark Countries.