Comparison of Short- and Long-Term Cardiovascular Disease Risk Assessment Tools in US Young Adults.

Background: In 2023, the American Heart Association published the Predicting Risk of Cardiovascular Disease Events (PREVENT) equations for estimating atherosclerotic cardiovascular disease (ASCVD) risk in adults aged 30 to 79 years. We compared PREVENT's performance with existing US guideline recommended models-Pooled Cohort Equations for 10-year ASCVD risk and FHS (Framingham Heart Study) equations for 30-year ASCVD risk-among young adults.

Methods: We analyzed adults aged 20 to 39 years without baseline ASCVD from 2 sources: (1) pooled data from 2 large epidemiologic cohorts (CARDIA [Coronary Artery Risk Development in Young Adults] and FHS, n=7763), and (2) electronic health records from Kaiser Permanente Southern California (n=266 378).

Benefit-harm trade-offs of intensive blood pressure control versus standard blood pressure control on cardiovascular and renal outcomes: an individual participant data analysis of randomised controlled trials.

Background: Although intensive blood pressure control is recommended by major guidelines, its overall benefit-harm balance remains uncertain. In particular, it is unclear how net clinical benefit varies by blood pressure target and patient characteristics. We aimed to quantify the benefit-harm trade-offs of intensive blood pressure control versus standard blood pressure control.

Association Between Fixed-Dose Combination Use and Medication Adherence, Health Care Utilization, and Costs Among Medicaid Beneficiaries.

Background: Fixed-dose combination (FDC) antihypertensives combine two or more agents. Compared with non-FDC antihypertensives of multiple classes (multi-pill therapy), combination-pill therapy using FDC antihypertensives may improve hypertension control. However, combination-pill therapy remains low.

Cost-Effectiveness of Hypertension Treatment According to 2017 American College of Cardiology and American Heart Association Guidelines.

Background: Compared with the 2003 Seventh Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7) guideline, the 2017 American College of Cardiology and American Heart Association guideline (ACC/AHA 2017) expanded hypertension diagnostic criteria to blood pressure (BP) ≥130/80 mm Hg and intensified treatment goals to <130/80 mm Hg. The cost-effectiveness of ACC/AHA 2017 guideline treatment has not been quantified.

Methods: We used the Cardiovascular Disease (CVD) Policy Model to simulate hypertension treatment according to ACC/AHA 2017 compared with JNC7 in untreated US adults aged 35 to 79 years.

Development and Validation of an Incident Hypertension Risk Prediction Model for Young Adults.

Background: Identifying young adults at high risk of hypertension can improve blood pressure screening recommendations.

Methods: We developed models to predict incident hypertension using diverse contemporary cohorts of young adults aged 18 to 39 years from Kaiser Permanente Southern California (derivation and internal validation) and 3 cohort studies (CARDIA [Coronary Artery Risk Development in Young Adults], FHS [Framingham Heart Study], HCHS/SOL [Hispanic Community Health Study/Study of Latinos]; external validation). Predictors included age, systolic and diastolic blood pressure, body mass index, smoking, social determinants of health, comorbidities, high- and low-density lipoprotein cholesterol, and pregnancy-related hypertensive disorders.

Economic Evaluation of the HEARTS Standardized Hypertension Treatment Program With Fixed-Dose Combination Pills in Chile Primary Care Clinics.

Objectives: In 2016, Chile implemented a pilot project in 2 Santiago-area family health centers aimed at improving hypertension control using the HEARTS framework for cardiovascular disease prevention. The core intervention replaced nonstandardized, single-medication regimens with standardized treatment using fixed-dose combination pills. Although prior studies demonstrate improved blood pressure control with fixed-dose combination pills, evidence on cost-effectiveness is essential for scalability.

Candidate Interventions for Integrating Hypertension and Cardiovascular-Kidney-Metabolic Care in Primary Health Settings: HEARTS 2.0 Phase 1.

Background: HEARTS in the Americas is the regional adaptation of the WHO Global HEARTS Initiative, aimed at helping countries enhance hypertension and cardiovascular disease (CVD) risk management in primary care settings. Its core implementation tool, the HEARTS Clinical Pathway, has been adopted by 28 countries. To improve the care of hypertension, diabetes, and chronic kidney disease (CKD), HEARTS 2.

Analysis of costs in implementing the HEARTS hypertension program in Nigerian primary care.

Background: The Nigeria Hypertension Control Initiative (NHCI) program, launched in 2020, integrates hypertension care into primary healthcare using the HEARTS technical package, which includes screening, health counselling, and standardized hypertension treatment protocols. This package has been piloted through NHCI in Kano and Ogun States and in the Federal Capital Territory (FCT) Abuja, as part of the Hypertension Treatment in Nigeria (HTN) project.

Objective: To assess the costs of scaling up the HEARTS hypertension control package and compare these costs with those of usual care.

Improved hypertension care requires measurement and management in health facilities, not mass screening.

Improved hypertension control can save millions of lives, but mass hypertension screening, a commonly used approach, is a barrier to progress. Although politically appealing, mass screening diverts resources from improving services in primary health care. Hypertension treatment requires ongoing, long-term care.

Costs of the HEARTS hypertension program in primary care in Lampang province, Thailand.

Background: In 2020, a pilot program for hypertension control was initiated in primary care facilities in Lampang Province, Thailand. The program followed the framework of the HEARTS program for standardized hypertension treatment, but the financial costs of the program are not well understood. This study evaluates the costs of the HEARTS approach compared to usual care to inform future scale-up efforts of the program.

Trends in Hypertension Prevalence, Awareness, Treatment, and Control Among US Young Adults, 2003-2023.

Background: This study evaluated recent trends in hypertension prevalence and management among US young adults, and assessed disparities by age, sex, or race and ethnicity, as well as potential factors contributing to the age-related disparities.

Methods: Data from 51,291 adults aged ≥18 years in the National Health and Nutrition Examination Survey 2003-2004 to 2021-2023 were analyzed. Stage 1 or 2 hypertension was defined as systolic/diastolic blood pressure (BP) ≥130/80 mmHg or antihypertensive medication use.

The Healthy Hearts program to improve primary care for hypertension in seven rural health units of Iloilo Province, Philippines: a comparative cost study.

Background: In 2021, the Philippines launched the Healthy Hearts demonstration project for delivering hypertension (HTN) services in seven Rural Health Units (RHUs) in District 1 of Iloilo Province, West Visayas Region. This study evaluates the provider time cost and medication cost of delivering these services under three medication procurement scenarios, projecting them to the district and province levels to inform scaling-up efforts.

Methods: A mixed-methods design was used for cost data collection, including key informant interviews (KII), focus group discussions (FGD), and secondary data sources.

Priorities for Research on Hypertension Care Delivery: A WHO Report Executive Summary.

In 2024, the World Health Organization released a report on Priorities for Research on Hypertension Care Delivery; this article provides its executive summary. The World Health Organization and its technical experts formed a leadership team, developed a scope and objectives, created a thematic framework, developed a survey for each theme, and identified research priorities. The 5 themes included (1) Health care workforce for hypertension care delivery, (2) Service delivery system/models, (3) Patient retention/adherence, (4) Financing the care delivery system, and (5) Research gaps identified in the World Health Organization 2021 Hypertension Guideline.

Effects of medication procurement reforms and extended prescription duration on medication coverage for hypertension in India's public health system: a modelling study.

Objectives: To estimate the effects of procurement reforms and extended prescription duration on medication coverage for hypertension in India's public health system.

Design: Simulation study incorporating data from governmental medication price lists, prescription pattern analyses, and market sales surveys.

Setting: Simulated hypothetical public healthcare facility in India treating 1000 patients with hypertension.

Evaluation and Comparison of the PREVENT and Pooled Cohort Equations for 10-Year Atherosclerotic Cardiovascular Risk Prediction.

Background: We compared the atherosclerotic cardiovascular disease (ASCVD) risk prediction performance of the American Heart Association's Predicting Risk of Cardiovascular Disease Events (PREVENT) Base and PREVENT Full equations (includes urine albumin/creatinine ratio, glycated hemoglobin, and social deprivation index) with the pooled cohort equations (PCEs).

Methods: We included adults, aged 40 to 75 years, with no history of ASCVD, diabetes, or statin use in 2009 from Kaiser Permanente Southern California and followed up through 2019. ASCVD was defined as myocardial infarction, fatal coronary heart disease, and fatal and nonfatal ischemic stroke.

Cost-Effectiveness of a Polypill for Cardiovascular Disease Prevention in an Underserved Population.

Importance: The Southern Community Cohort Study (SCCS) Polypill Trial showed that a cardiovascular polypill (a single pill containing a statin and 3 half-standard dose antihypertensive medications) effectively controls cardiovascular disease (CVD) risk factors in a majority Black race and low-income population. The cost-effectiveness of polypill treatment in this population has not been previously studied.

Objective: To determine the cost-effectiveness of the cardiovascular polypill.

Integrated Antihypertensive and Statin Treatment Protocols for Cardiovascular Disease Prevention in Low- and Middle-Income Countries.

In low- and middle-income countries where the majority of preventable cardiovascular disease deaths occur, less than 10% of eligible patients receive statins for primary cardiovascular disease prevention. Since 2017, the Global Hearts initiative has implemented simple World Health Organization (WHO) HEARTS hypertension and diabetes treatment protocols. In this editorial, we propose an approach of integrating statin treatment into existing HEARTS hypertension and diabetes protocols as a way of expanding statin coverage in low-and middle-income countries.

Effectiveness and Safety of Using Standardized Treatment Protocols for Hypertension Compared to Usual Care: A Meta-Analysis of Randomized Clinical Trials.

Large gaps persist in the diagnosis, awareness, treatment, and control of hypertension globally. Standardized treatment protocols (STPs) have been widely proposed to guide hypertension treatment, particularly in primary healthcare settings. However, there has been no review that quantifies the effects of hypertension STPs on blood pressure (BP) reduction and control.

Risk-enhancing factors and social determinants of health in risk assessment for atherosclerotic cardiovascular disease.

Background: The Pooled Cohort Equations (PCEs) do not accurately estimate atherosclerotic cardiovascular disease (ASCVD) risk in certain populations. The 2018 AHA/ACC cholesterol guideline identified risk-enhancing factors as a supplement to PCEs-based risk assessment. However, the role of each risk-enhancing factor in ASCVD risk assessment has not been well quantified.