Evidence-informed update process for the HEARTS 2.0 Clinical Pathway: HEARTS 2.0 Phase 3: Integrating hypertension into cardiovascular–kidney–metabolic care in primary health care settings

Description

Cardiovascular–kidney–metabolic (CKM) conditions are globally recognized as the most significant contributors to premature death and disability, demanding an urgent, integrated public health response. Building upon the successful HEARTS in the Americas initiative – which has already established a robust platform for hypertension control across the Region of the Americas – the HEARTS 2.0 project aimed to strategically expand its clinical pathway to address the broader CKM syndemic. The core objective was to achieve an expert consensus on a comprehensive set of 45 candidate interventions for primary health care that move beyond blood pressure alone.

This publication describes the procedure carried out during HEARTS 2.0 Phase 3 with the aim of reaching an evidence-based consensus on key interventions to be integrated into the HEARTS 2.0 Clinical Pathway. It also includes a detailed summary of the evidence for each of the candidate interventions and their GRADE assessments.
A rigorous, evidence-informed methodology, adapted from the RAND/UCLA Appropriateness Method, was applied. Forty-five candidate interventions, covering critical aspects of CKM care, were presented to a Clinical Pathway Development Group comprised of international experts. Through a structured scoring process, these experts rated each intervention based on its appropriateness for inclusion in the HEARTS 2.0 Clinical Pathway.

The analysis led to the definitive validation of the integrated approach: 38 of the 45 candidate interventions were designated as appropriate for inclusion in the updated HEARTS 2.0 Clinical Pathway. Furthermore, the consensus strongly endorsed the early use of high-impact therapeutics, such as high-intensity statin regimens and sodium-glucose co-transporter 2 inhibitors, especially for high-risk patients with coexisting CKM conditions. Crucially, the process confirmed the necessity of leveraging the entire primary health care team, empowering nonphysician healthcare workers to intensify medication and provide adherence support.

The seven remaining interventions were classified as “uncertain,” reflecting areas where regional feasibility or available evidence required further scrutiny. In conclusion, this Phase 3 consensus provides the evidence-based, expert-validated framework for the new HEARTS 2.0 Clinical Pathway, marking a deep advancement in the capacity of primary health care services across the Americas to deliver comprehensive, high-quality, and standardized CKM care.