Evidence-Informed Prioritization of Interventions for Integrating Hypertension Management into Cardiovascular-Kidney-Metabolic Care in Primary Health Care: HEARTS 2.0 Phase 3.

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. OBJECTIVE: 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. CONCLUSION: 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.

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PubMed
Published
2026-04-22
DOI
https://doi.org/10.1093/ajh/hpag033
Citations
1
Primary Topic
Blood Pressure and Hypertension Studies
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article
Field-Weighted Citation Impact
17.82
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article

Evidence-Informed Prioritization of Interventions for Integrating Hypertension Management into Cardiovascular-Kidney-Metabolic Care in Primary Health Care: HEARTS 2.0 Phase 3.

Libardo Rodriguez Martinez, Marcela Rivera, Irmgardt Alicia Wellmann, Marc G. Jaffe et al.
1 citations
PubMed
Blood Pressure and Hypertension Studies
17.82
article

Evidence-Informed Prioritization of Interventions for Integrating Hypertension Management into Cardiovascular-Kidney-Metabolic Care in Primary Health Care: HEARTS 2.0 Phase 3.

Libardo Rodriguez Martinez, Marcela Rivera, Irmgardt Alicia Wellmann, Marc G. Jaffe, Yamilé Valdés González, Ludovic Revéiz, Natalia Vensentini, Carolina Neira Ojeda, Emily Ridley, Andelys De la Rosa, Ariel Izcovich, Andrés Rosende, Pedro Ordúñez, Santiago Torroba, Sonia Y. Angell, César A. Romero, Niamh Chapman, Gonzalo Rodríguez, Taskeen Khan, Donald J. DiPette, Javier Mariani, Eric Zúñiga, Ana Cláudia de Souza, Esteban Londoño, Fernando Tortosa, Miguel Angel Diaz Aguilera, Ana Marcela Torres, Vilma Irazola, Jeffrey Brettler, Lourdes Jarquin, Andrew E Moran, David Flood, Paula Diaz Valencia, Maria Florencia Grande Ratti, Paul K Whelton, Norm R C Campbell, Mariana L Rodriguez de la Cerda
article en
1 citations

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. OBJECTIVE: 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. CONCLUSION: 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.

PubMed
Tulane University (US), Prisma Health (US), The University of Sydney (AU), Universidad de Antofagasta (CL), Kaiser Permanente (US), Johns Hopkins University (US), Emory University (US), University of South Carolina (US), University of Calgary (CA), University of Michigan (US), Columbia University Irving Medical Center (US), Universidad de Antioquia (CO), Hospital Moinhos de Vento (BR), Ministry of Health (TO), World Health Organization Regional Office for the Americas (US), Ministry of Health (CL), Michigan Medicine (US), Ministerio de Salud Pública (CU), Instituto de Efectividad Clínica y Sanitaria (AR), Institute of Nutrition of Central America and Panama (GT), Ministerio de Salud (SV), Sydney Local Health District (AU), Hospital El Cruce (AR), Favaloro Foundation (AR), Center for Non-Communicable Diseases (PK), Western Sydney University (AU), Pan American Health Organization (Cuba) (CU), Qatar Foundation (QA)
Openalex Percentile: Top 1%
Blood Pressure and Hypertension Studies
17.82
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