Bridging the Gap in Hypertension Care Delivery, With Swapnil Hiremath, MD, MPH

Hypertension remains one of the most consequential but uncontrolled drivers of global morbidity and mortality. Affecting more than 1 billion people worldwide, it is the leading modifiable risk factor for death, contributing to millions of preventable deaths each year.

Despite the availability of effective, low-cost therapies, blood pressure control rates have stagnated or even declined in many regions, highlighting a critical gap not in knowledge, but in implementation. Programs like the World Health Organization’s Global HEARTS Initiative aim to close this gap by focusing on scalable, system-level solutions.

In an interview with HCPLive at at the World Congress of Nephrology (WCN) Conference in Yokohama, Japan, Swapnil Hiremath, MD, MPH, a nephrologist at the Ottawa Hospital and professor at the University of Ottawa, emphasized that the challenge is not a lack of effective treatments, but rather the failure to consistently apply simple, evidence-based strategies in real-world settings.

“Even if you look at high income countries, BP control is hard, and sometimes we don't do the simple things well,” Hiremath said.

He notes that even modest reductions in blood pressure can yield substantial benefits, including meaningful decreases in cardiovascular events, stroke, heart failure, and overall mortality. However, these gains are often unrealized due to fragmented care systems, limited access to medications, and clinical inertia.

The HEARTS framework, he explains, is designed to address these barriers through a comprehensive yet practical approach. Built around key pillars including healthy lifestyle counseling, standardized treatment protocols, access to essential medications, risk-based management, team-based care, and systems for monitoring, HEARTS prioritizes feasibility and adaptability across diverse healthcare settings.

Hiremath notes that a central component of this approach is the emphasis on affordability and accessibility. He highlights the strategic use of widely available, low-cost medications such as calcium channel blockers, angiotensin receptor blockers, and thiazide diuretics, therapies selected not only for efficacy, but also for their safety profiles and minimal need for laboratory monitoring, which are critical considerations in low-resource environments where access to follow-up care may be limited.

He also underscores the importance of team-based care models, which enable non-physician providers to follow structured treatment algorithms and escalate therapy efficiently. This approach helps overcome workforce limitations and reduces delays in treatment intensification, a common contributor to poor blood pressure control.

While the program has made meaningful progress, reaching tens of millions of individuals across dozens of countries, Hiremath notes that this represents only a fraction of the global burden. Expanding implementation will require sustained political commitment, local adaptation, and continued focus on health system strengthening.

“The solutions are there. We don't have to invent a vaccine, we don't need new technology, we don't need any fancy drugs,” he said. “We have the tools, it's just about implementation.”

Editors’ Note: Hiremath reports no relevant disclosures.

References

1. Farrar J, Frieden T. WHO global report on hypertension 2025. The Lancet. doi:10.1016/S0140-6736(25)02208-1

2. World Health Organization. Global Hearts Initiative. Accessed March 29, 2026. https://www.who.int/initiatives/global-hearts-initiative