# WHO HEARTS technical package

Intervention · id `cardio:who-hearts` · Cardiovascular Atlas · release `5dcd9b263fe17744` (public)

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Also called: HEARTS; HEARTS technical package

Browse, organ or system: Blood vessels  
Browse, condition area: Risk and prevention; High blood pressure  

## In plain language

WHO's HEARTS technical package is a set of modules for managing high blood pressure and other cardiovascular risk in primary health care. WHO lists six modules and an implementation guide: healthy-lifestyle counselling, evidence-based treatment protocols, access to essential medicines and technology, risk-based cardiovascular disease management, team-based care and systems for monitoring. WHO says a detailed, standardized treatment protocol is a critical first step in a large-scale hypertension programme. In a matched-pair trial in rural Bangladesh, clinics using the package had lower blood pressure and better control at 6 months than usual-care clinics.

## Technical summary

The WHO publication page dates the package 27 December 2016 (76 pages, ISBN 9789241511377). WHO's 2023 Global report on hypertension says the package was launched in 2018 as the core technical package of the Global Hearts Initiative. The two dates are given as the sources state them and are not reconciled. This record did not read the module PDFs; the module list comes from the WHO publication page and the 2023 report. The one evaluation recorded is a quasi-experimental trial, not a randomized one.

## Claims, with the population each applies to

## Context: Adults with uncontrolled hypertension in rural Bangladesh primary care (HEARTS evaluation)

Recipient: Adult; Population: 3935 patients (mean age 52.3 years, 70.5% female) with uncontrolled hypertension, defined as blood pressure of 140/90 mm Hg or higher regardless of treatment history (abstract). The registry gives a minimum age of 18 years.; Care setting: Fourteen Upazila Health Complexes (primary healthcare facilities): 7 implementing the WHO HEARTS package and 7 matched usual care sites.; Geography: Rural Bangladesh; Life stage: Adults; the registry gives a minimum age of 18 years and no maximum; the mean age was 52.3 years; Follow-up: The primary outcome was measured at 6 months at the patient's home. Because of severe flooding at several sites, follow-up was extended by 2 months where needed, in both groups.

### A matched-pair cluster quasi-experimental trial in 14 Upazila Health Complexes (primary healthcare facilities) in rural Bangladesh compared 7 clinics implementing the WHO HEARTS technical package with 7 matched clinics continuing usual hypertension care. It enrolled 3935 patients (mean age 52.3 years, 70.5% female) with uncontrolled hypertension (blood pressure of 140/90 mm Hg or higher regardless of treatment history): 1950 from the HEARTS clinics and 1985 from the usual care clinics. At 6 months, 95.5% of participants completed follow-up. Compared with usual care, the intervention lowered systolic blood pressure (-23.7 mm Hg against -20.0 mm Hg; net difference -3.7 mm Hg, 95% CI -5.1 to -2.2) and diastolic blood pressure (-10.2 mm Hg against -8.3 mm Hg; net difference -1.9 mm Hg, 95% CI -2.7 to -1.1), and improved hypertension control (62.0% against 49.7%; net difference 12.3%, 95% CI 9.0 to 16.8). The rate of missed clinic visits was lower in the intervention group (8.8% against 39.3%, p<0.001).

- Category: Effect
- Evidence stage: Interventional
- Certainty: Certainty not assessed
- Applies to: Recipient: Adult; Population: 3935 patients (mean age 52.3 years, 70.5% female) with uncontrolled hypertension, defined as blood pressure of 140/90 mm Hg or higher regardless of treatment history (abstract). The registry gives a minimum age of 18 years.; Care setting: Fourteen Upazila Health Complexes (primary healthcare facilities): 7 implementing the WHO HEARTS package and 7 matched usual care sites.; Geography: Rural Bangladesh; Life stage: Adults; the registry gives a minimum age of 18 years and no maximum; the mean age was 52.3 years; Follow-up: The primary outcome was measured at 6 months at the patient's home. Because of severe flooding at several sites, follow-up was extended by 2 months where needed, in both groups.
- Limitations: The trial was not randomized: clinics were matched, not randomly assigned, so differences between clinics may contribute to the results. The primary outcome was systolic blood pressure at 6 months, measured at the patient's home. Severe flooding affected both groups towards the end of follow-up, and follow-up was extended by 2 months where needed. The intervention group was more affected: more of its patients reported the flood prevented them from attending 1 or more clinic visits (30% against 8%) and from getting a medication refill (27% against 9%). The paper planned a sample of 2100 and kept enrolling after reaching it. The registry's primary completion date (2021-12-31) is earlier than the 6-month follow-up the paper describes; the two are not reconciled here. The result is for rural primary care clinics in one country.
- Last checked: 2026-10-15
- Sources:
  1. Supports: Evaluation of the World Health Organization-HEARTS hypertension control package in Bangladesh: a quasi-experimental trial (Publication, edition PMC Open Access subset full-text XML, from NCBI E-utilities.) <https://pmc.ncbi.nlm.nih.gov/articles/PMC11347191/>
     Locator: Abstract, Results, sentences 1 to 4. Retrieved 2026-10-15T13:48:16Z. Source state: Current. Snapshot hash: 4c2a7ee6c72919572f679c541fa1afb5ceaf308ca030a04059c1c4ae17df1071.
     How it applies: Blood pressure, hypertension control and missed visit results.
  2. Background: Evaluation of the World Health Organization-HEARTS hypertension control package in Bangladesh: a quasi-experimental trial (Publication, edition PMC Open Access subset full-text XML, from NCBI E-utilities.) <https://pmc.ncbi.nlm.nih.gov/articles/PMC11347191/>
     Locator: Abstract, Methods, sentences 1 to 3. Retrieved 2026-10-15T13:48:16Z. Source state: Current. Snapshot hash: 4c2a7ee6c72919572f679c541fa1afb5ceaf308ca030a04059c1c4ae17df1071.
     How it applies: Design, participants and outcomes.
  3. Background: Evaluation of the World Health Organization-HEARTS hypertension control package in Bangladesh: a quasi-experimental trial (Publication, edition PMC Open Access subset full-text XML, from NCBI E-utilities.) <https://pmc.ncbi.nlm.nih.gov/articles/PMC11347191/>
     Locator: Results, Implementation outcomes at 6 months, final paragraph. Retrieved 2026-10-15T13:48:16Z. Source state: Current. Snapshot hash: 4c2a7ee6c72919572f679c541fa1afb5ceaf308ca030a04059c1c4ae17df1071.
     How it applies: Severe flooding during follow-up and its unequal effect.
  4. Background: HEARTS Package Evaluation Trial in Bangladesh (Registry, edition ClinicalTrials.gov API v2 record, last update posted 2023-07-14.) <https://clinicaltrials.gov/study/NCT04992039>
     Locator: protocolSection.designModule.designInfo.allocation. Retrieved 2026-10-15T13:48:11Z. Source state: Current. Snapshot hash: dd7a61ffbd1f02510e1352432117329bf21799162ce228d164bf33c140f20f44.
     How it applies: The registry lists allocation as non-randomized.

## Context: Primary health care programmes for hypertension and cardiovascular risk (WHO HEARTS package)

Recipient: Recipient not specified; Population: Not defined by age or condition in the sources read. WHO describes the package as the public health approach to managing hypertension and other cardiovascular disease risk factors at the primary health care level.; Care setting: Primary health care.; Geography: Worldwide programme; the sources read give no single country.; Life stage: Not stated in the source; Gestational age: Not reported; Postnatal age: Not reported; Follow-up: Not stated in the source.

### WHO lists the HEARTS technical package as six modules and an implementation guide: healthy-lifestyle counselling, evidence-based treatment protocols, access to essential medicines and technology, risk-based cardiovascular disease management, team-based care and systems for monitoring. The WHO publication page, which dates the package 27 December 2016, says creating and endorsing a detailed and standardized treatment protocol is a critical first step in developing a successful large-scale hypertension programme. WHO's 2023 Global report on hypertension says the package was launched in 2018 as the core technical package of the Global Hearts Initiative and is the public health approach to managing hypertension and other cardiovascular disease risk factors at the primary health care level.

- Category: Description
- Evidence stage: Guidance
- Certainty: Certainty not assessed
- Applies to: Recipient: Recipient not specified; Population: Not defined by age or condition in the sources read. WHO describes the package as the public health approach to managing hypertension and other cardiovascular disease risk factors at the primary health care level.; Care setting: Primary health care.; Geography: Worldwide programme; the sources read give no single country.; Life stage: Not stated in the source; Gestational age: Not reported; Postnatal age: Not reported; Follow-up: Not stated in the source.
- Limitations: This describes what the package contains. It is not evidence that the package works; the one evaluation recorded here is a non-randomized trial on its own claim. The two WHO sources give different dates (2016 and 2018) and the difference is not reconciled here. The module PDFs were not read.
- Last checked: 2026-10-15
- Sources:
  1. Supports: Global report on hypertension: the race against a silent killer (Publication, edition WHO publication page and English PDF from WHO IRIS, both fetched 2026-10-15. The page dates the report 19 September 2023. The PDF has 291 pages.) <https://www.who.int/publications/i/item/9789240081062>
     Locator: PDF page 53, section 5.4 HEARTS for hypertension control. Retrieved 2026-10-15T13:51:15Z. Source state: Current. Snapshot hash: 67b96f51a8e8b8261319eb59f0b09b970628c74f068c28b92bcb858ce0ac502b.
     How it applies: Launch year, purpose and the six modules.
  2. Supports: HEARTS: Technical package for cardiovascular disease management in primary health care (Publication, edition WHO publication page fetched 2026-10-15; the page dates the package 27 December 2016 and lists 76 pages. The module PDFs were not fetched.) <https://www.who.int/publications/i/item/9789241511377>
     Locator: Publication details and Overview. Retrieved 2026-10-15T13:49:16Z. Source state: Current. Snapshot hash: 7ba6c36300ca929fed88f18a37ac4c42574e145be460a8907bd54768333486a4.
     How it applies: Publication date and the treatment protocol statement.

## Connected pages

- Rural Bangladesh primary care, adults with uncontrolled hypertension, matched-pair non-randomized trial: lower blood pressure and better control at 6 months: Hypertension (high blood pressure) (`core:hypertension`) [a claim, not a settled fact; see claim `cardio:claim-hearts-bangladesh-bp-control` and its context]
- WHO technical package: World Health Organization (`cardio:who`)
- Filed under this front: Prevention and lifestyle (`cardio:front-prevention-and-lifestyle`)
- Investigated in: WHO HEARTS evaluation in Bangladesh (`cardio:hearts-bangladesh`)

## Provenance

Content hash: d7b2130151f806fe129243ddc8896903d021ff82f937bec381f57cf33fcf5b3e
Last substantive edit: 2026-10-15
Evidence last checked: 2026-10-15