Reach and effectiveness of a HEARTS hypertension control pilot project in Guatemala

The World Health Organizations HEARTS Technical Package aims to improve the primary care management of hypertension and other cardiovascular risk disease factors at the population level. This study describes the first HEARTS implementation project in the Ministry of Health primary care system in Guatemala. This pilot project was implemented from April to December 2022 in 6 primary health facilities in 3 rural, Indigenous municipalities. The project consisted of HEARTS-aligned strategies that were adapted to foster program sustainability in Guatemala. Outcomes were defined using the RE-AIM framework. The primary reach outcome was treatment rate, defined as the absolute number of patients each month receiving medication treatment for hypertension. The primary effectiveness outcomes were mean systolic blood pressure (BP), mean diastolic BP, and proportion with BP control. In the first month of the post-implementation period, there was a significant increase of 25 patients treated (P=0.002), followed by a significant increase thereafter of 2.4 additional patients treated each month (P=0.007). The mean change in systolic BP was -4.4 (95 CI -8.2 to -0.5, P=0.028) mmHg and mean change in diastolic BP was -0.9 (95 CI -2.8 to 1.1, P=0.376) mmHg. The proportion of the cohort with BP control increased from 33.4% at baseline to 47.1% at 6 months (adjusted change of 13.7% [95 CI 2.2% to 25.2%, P=0.027]). These findings support the feasibility of implementing the HEARTS model for blood pressure control in the Guatemalan MOH primary care system where the vast majority of hypertension patients seek care.