School of Medicine, University of South Carolina, Columbia, SC, USA.
Women Influencing Health, Education and Rule of Law (WI-HER), Vienna, VA, USA.
J Clin Hypertens (Greenwich). 2020 Dec;22(12):2285-2295. doi: 10.1111/jch.14072. Epub 2020 Oct 12.
Hypertension is the leading risk factor for cardiovascular disease (CVD) worldwide. Despite the availability of effective antihypertensive medications, the control of hypertension at a global level is dismal, and consequently, the CVD burden continues to increase. In response, countries in Latin America and the Caribbean are implementing the HEARTS in the Americas, a community-based program that focuses on increasing hypertension control and CVD secondary prevention through risk factor mitigation. One key pillar is the implementation of a standardized hypertension treatment protocol supported by a small, high-quality formulary. This manuscript describes the methodology used by the HEARTS in the Americas program to implement a population-based standardized hypertension treatment protocol. It is rooted in a seamless transition from existing treatment practices to best practice using pharmacologic protocols built around a core set of ideal antihypertensive medications. In alignment with recent major hypertension guidelines, the HEARTS in the Americas protocols call for the rapid control of blood pressure, through the use of two antihypertensive medications, preferably in the form of a single pill, fixed-dose combination, in the initial treatment of hypertension. To date, the HEARTS in the Americas program has seen the improvement in antihypertensive medication formularies and the establishment of pharmacologic treatment protocols tailored to individual participating countries. This has translated to significant increases in hypertension control rates post-program implementation in these jurisdictions. Thus, the HEARTS in the Americas program could serve as a model, for not only the Americas Region but globally, and ultimately decrease the burden of CVD.
高血压是全球心血管疾病（CVD）的主要危险因素。尽管有有效的降压药物，但全球范围内高血压的控制情况仍不容乐观，因此 CVD 的负担仍在继续增加。针对这一问题，拉丁美洲和加勒比地区的国家正在实施“心脏健康行动在美洲”（HEARTS in the Americas）项目，该项目以社区为基础，旨在通过减轻风险因素来提高高血压控制率和 CVD 的二级预防。其中一个关键支柱是实施标准化高血压治疗方案，该方案得到一个小而高质量的处方集的支持。本文档介绍了“心脏健康行动在美洲”项目实施基于人群的标准化高血压治疗方案所采用的方法。它基于从现有治疗实践无缝过渡到最佳实践，使用围绕一组理想降压药物构建的药理学方案。与最近的主要高血压指南一致，“心脏健康行动在美洲”方案呼吁通过使用两种降压药物（最好以单片固定剂量复方的形式）快速控制血压，这是高血压初始治疗的基础。迄今为止，“心脏健康行动在美洲”方案已经看到了降压药物处方集的改善和针对个别参与国家的药理学治疗方案的制定。这导致这些司法管辖区在方案实施后高血压控制率显著提高。因此，“心脏健康行动在美洲”方案不仅可以作为美洲地区的模式，而且可以作为全球的模式，最终降低 CVD 的负担。
