Evidence-informed prioritization of interventions for integrating hypertension management into cardiovascular-kidney-metabolic care in primary health care: HEARTS 2.0 Phase 3

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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. 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. Conclusions: 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.
Funding Information
  • Pan American Health Organization
  • HEARTS in the Americas for Better Health Care for NCDs (607009)

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