WHO HEARTS technical package

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.

Also called HEARTS · HEARTS technical package

Intervention
In this atlas

Overview

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.

About this intervention

Type: Service
Mechanism: A primary-care package with six modules (lifestyle counselling, treatment protocols, access to essential medicines and technology, risk-based management, team-based care and monitoring systems) and an implementation guide.

Claims and evidence

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.

Eligibility: 2 inclusion criteria; 1 exclusion criterion

Included: Aged 18 and above (registry)
A diagnosis of hypertension with baseline systolic blood pressure of 140 mmHg or higher and/or diastolic of 90 mmHg or higher (registry)
Excluded: Previously diagnosed hypertension with controlled blood pressure at the time of enrollment (registry)

Effect Interventional Certainty not assessed

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).
Applies to Adult
- 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.
- Fourteen Upazila Health Complexes (primary healthcare facilities): 7 implementing the WHO HEARTS package and 7 matched usual care sites.
- Rural Bangladesh
- 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.
Certainty method
Not assessed

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

Next evidence check due
Not scheduled
Sources and citations (4)
1. Supports Evaluation of the World Health Organization-HEARTS hypertension control package in Bangladesh: a quasi-experimental trial
  
  Publication · Heart · Edition PMC Open Access subset full-text XML, from NCBI E-utilities. · PMCID: PMC11347191 · PMID: 39019496 · DOI: 10.1136/heartjnl-2024-324253
  
  Locator
  Abstract, Results, sentences 1 to 4
  
  How it applies
  Blood pressure, hypertension control and missed visit results.
  
  Retrieved
  2026-10-15T13:48:16Z
  
  Source effective date
  Not reported
  
  Source state
  Current
  
  Snapshot hash
  4c2a7ee6c72919572f679c541fa1afb5ceaf308ca030a04059c1c4ae17df1071
  
  Reuse basis
  PMC Open Access subset article under https://creativecommons.org/licenses/by/4.0/. The article's own <permissions> states the licence. The XML is committed unaltered, with the citation and licence kept in the file. The raw file is committed at research/snapshots/cl-pmc-PMC11347191.xml.
2. Background Evaluation of the World Health Organization-HEARTS hypertension control package in Bangladesh: a quasi-experimental trial
  
  Publication · Heart · Edition PMC Open Access subset full-text XML, from NCBI E-utilities. · PMCID: PMC11347191 · PMID: 39019496 · DOI: 10.1136/heartjnl-2024-324253
  
  Locator
  Abstract, Methods, sentences 1 to 3
  
  How it applies
  Design, participants and outcomes.
  
  Retrieved
  2026-10-15T13:48:16Z
  
  Source effective date
  Not reported
  
  Source state
  Current
  
  Snapshot hash
  4c2a7ee6c72919572f679c541fa1afb5ceaf308ca030a04059c1c4ae17df1071
  
  Reuse basis
  PMC Open Access subset article under https://creativecommons.org/licenses/by/4.0/. The article's own <permissions> states the licence. The XML is committed unaltered, with the citation and licence kept in the file. The raw file is committed at research/snapshots/cl-pmc-PMC11347191.xml.
3. Background Evaluation of the World Health Organization-HEARTS hypertension control package in Bangladesh: a quasi-experimental trial
  
  Publication · Heart · Edition PMC Open Access subset full-text XML, from NCBI E-utilities. · PMCID: PMC11347191 · PMID: 39019496 · DOI: 10.1136/heartjnl-2024-324253
  
  Locator
  Results, Implementation outcomes at 6 months, final paragraph
  
  How it applies
  Severe flooding during follow-up and its unequal effect.
  
  Retrieved
  2026-10-15T13:48:16Z
  
  Source effective date
  Not reported
  
  Source state
  Current
  
  Snapshot hash
  4c2a7ee6c72919572f679c541fa1afb5ceaf308ca030a04059c1c4ae17df1071
  
  Reuse basis
  PMC Open Access subset article under https://creativecommons.org/licenses/by/4.0/. The article's own <permissions> states the licence. The XML is committed unaltered, with the citation and licence kept in the file. The raw file is committed at research/snapshots/cl-pmc-PMC11347191.xml.
4. Background HEARTS Package Evaluation Trial in Bangladesh
  
  Registry · U.S. National Library of Medicine (ClinicalTrials.gov) · Edition ClinicalTrials.gov API v2 record, last update posted 2023-07-14. · NCT: NCT04992039
  
  Locator
  protocolSection.designModule.designInfo.allocation
  
  How it applies
  The registry lists allocation as non-randomized.
  
  Retrieved
  2026-10-15T13:48:11Z
  
  Source effective date
  2023-07-14
  
  Source state
  Current
  
  Snapshot hash
  dd7a61ffbd1f02510e1352432117329bf21799162ce228d164bf33c140f20f44
  
  Reuse basis
  Registry record. The raw API JSON is committed. The ClinicalTrials.gov terms page is rendered by JavaScript and its text was not read by a script, so the redistribution basis is unverified; any quotation stays short. The raw file is committed at research/snapshots/cl-ctgov-NCT04992039.json.

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.

Eligibility: inclusion criteria not stated; exclusion criteria not stated

Included: None stated
Excluded: None stated

Description Guidance Certainty not assessed

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.
Applies to Recipient not specified
- 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.
- Primary health care.
- Worldwide programme; the sources read give no single country.
- Not stated in the source
- Gestational age Not reported
- Postnatal age Not reported
Follow-up Not stated in the source.
Certainty method
Not assessed

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

Next evidence check due
Not scheduled
Sources and citations (2)
1. Supports Global report on hypertension: the race against a silent killer
  
  Publication · World Health Organization · 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. · Published 2023-09-19 · ISBN: 978-92-4-008106-2
  
  Locator
  PDF page 53, section 5.4 HEARTS for hypertension control
  
  How it applies
  Launch year, purpose and the six modules.
  
  Retrieved
  2026-10-15T13:51:15Z
  
  Source effective date
  Not reported
  
  Source state
  Current
  
  Snapshot hash
  67b96f51a8e8b8261319eb59f0b09b970628c74f068c28b92bcb858ce0ac502b
  
  Reuse basis
  The PDF states the work is available under CC BY-NC-SA 3.0 IGO (copyright page, PDF page 4). Short quotations with attribution only, until the atlas settles its public data licence. The WHO terms of use (fetched 2026-10-15 as cl-who-terms-of-use.html, sha256 8edac88c0773639d74a023402b231adafb407e8a680e6620c099eb5a17fb61ab, hash only) say extracts of the web site may be reproduced for research or private study but not for sale or for commercial use, with acknowledgment of WHO as the source. Hashes only; neither the page nor the PDF is committed.
2. Supports HEARTS: Technical package for cardiovascular disease management in primary health care
  
  Publication · World Health Organization · 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. · Published 2016-12-27 · ISBN: 9789241511377
  
  Locator
  Publication details and Overview
  
  How it applies
  Publication date and the treatment protocol statement.
  
  Retrieved
  2026-10-15T13:49:16Z
  
  Source effective date
  Not reported
  
  Source state
  Current
  
  Snapshot hash
  7ba6c36300ca929fed88f18a37ac4c42574e145be460a8907bd54768333486a4
  
  Reuse basis
  The WHO terms of use (fetched 2026-10-15 as cl-who-terms-of-use.html, sha256 8edac88c0773639d74a023402b231adafb407e8a680e6620c099eb5a17fb61ab, hash only) say extracts of the web site may be reproduced for research or private study but not for sale or for commercial use, with acknowledgment of WHO as the source. Public text is quote, with short quotations only and attribution. Hash only; the page is not committed.

Clinical links

Each link reports what one cited claim says about one population. "Evaluated for" means studied, not shown to work. These links do not show that anything is effective or right for you.

Claim, not a settled fact 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) (Evaluated for)
Applies to Adult
- 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.
- Fourteen Upazila Health Complexes (primary healthcare facilities): 7 implementing the WHO HEARTS package and 7 matched usual care sites.
- Rural Bangladesh
- 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).
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.

Record details

Record id: cardio:who-hearts
Content hash: d7b2130151f806fe129243ddc8896903d021ff82f937bec381f57cf33fcf5b3e