Implementation of a Resistant Hypertension Control Program in a Low-income Primary Care Setting in a High-Income Country: Lessons Learned and Global Applicability

Hypertension is one of the leading causes of cardiovascular disease-related morbidity and mortality globally. Over the last several decades, there has been a broad shift in the management and pharmacologic treatment, specifically of hypertension, from a step-care approach to an individualized approach, and now to a population-based approach to increase the control rate of hypertension with the overall goal of decreasing major cardiovascular events related to poor control of hypertension. The Global HEARTS initiative of the World Health Organization and the HEARTS in the Americas Program of the Pan American Health Organization, in addition to the efforts of other organizations, serve as a blueprint for the implementation of a standardized, population-based approach to treating hypertension in the primary health-care setting. We have implemented components of such a program in our primary care clinic and resistant hypertension clinic here in Columbia, South Carolina, U.S. While the U.S. is a high-income country, the demographics of our clinic is one of low income and health literacy and our population is primarily black and Hispanic, female, and of an older age. Our clinic has successfully applied population-based treatment principles on an individualized basis to improve hypertension control rates and cardiovascular disease in our local community.