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

The World Health Organization’s 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. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement Funding support was provided by Resolve to Save Lives ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics committee/IRB of Instituto de Nutrición de Centro América y Panamá gave ethical approval for this work. Ethics committee/IRB of Ministerio de Salud Pública y Asistencia Social de Guatemala gave ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors