JULIO 2026
By Dr. Pablo Gulayin y Dr. Vilma Irazola*
High blood pressure is the leading modifiable risk factor for cardiovascular and cerebrovascular disease. The 2019 Global Burden of Disease Study estimated that it was responsible for approximately ten million deaths, contributing substantially to the burden of cardiovascular disease, particularly in low- and middle-income countries.
In our country, it is estimated that high blood pressure affects more than a third of the adult populationAccording to the latest National Survey of Risk Factors, approximately 1 in 3 people who were unaware they had hypertension had elevated blood pressure, slightly more than half of those with known hypertension were under treatment, and among these, 6 out of 10 had elevated blood pressure during the evaluation.
Despite its high prevalence and the enormous impact it has on population health, Diagnosis, treatment, and control rates remain lowThis raises an uncomfortable but necessary question: Are we still failing at the basics?
A critical point is the clinical inertia and inappropriate variability in medical practiceThe persistence of practices guided by "usual practice," often not aligned with clinical practice guidelines, limits adequate blood pressure control. Even today, we observe a high proportion of patients treated with monotherapy, when evidence and guidelines recommend initiating combination therapies early to achieve better control. This is compounded by frequent delays in starting antihypertensive treatment, as doctors wait for lifestyle changes to control blood pressure in patients for whom the protective effect of medications is documented, and whose benefits require blood pressure reductions that cannot be achieved solely through lifestyle modifications.
Furthermore, the barriers to access and socioeconomic inequalities These factors undermine continuous, comprehensive, and quality healthcare, becoming key determinants of existing inequities in cardiovascular health. Hypertension is not only more common and disproportionately affects those living in low- and middle-income countries, where health systems are weaker, but it also generates a greater burden of disease, disability, and premature death in the most vulnerable populations of these countries, contributing to perpetuating a vicious cycle between disease and impoverishment.
Added to this reality is the daily reality of health systems, characterized by a High demand and limited consultation timeThis can often result in a lack of systematic measurement, incomplete measurements, or measurements that do not follow international standards, including the use of validated blood pressure monitors, hindering the diagnosis, monitoring, and control of hypertension. It can also lead to an incomplete assessment of cardiovascular risk, limiting the ability to effectively guide preventive interventions based on long-term overall cardiovascular risk assessment.
It is also important to point out that one of the main challenges is the therapeutic adherence In chronic treatments in general, adherence is a significant public health problem, even more so in low- and middle-income countries. It has been observed that low adherence among hypertensive patients is approximately 45%, and this proportion rises to 83,7% among individuals with uncontrolled blood pressure. Adherence is a cornerstone of chronic disease management, yet it remains an underestimated problem. In daily practice, there is little systematic recording, scant measurement, and almost no structured interventions to improve it.
In short, despite having more evidence, better treatments and updated guidelines, population-level results are still far from what was expected. The gap doesn't seem to be in knowledge, but in implementation.
Generating evidence is not enough if we cannot translate that evidence into better practices and policies in the real world. Based on this premise, we develop studies that seek to understand which interventions work best in local contexts, what the barriers and facilitators are to their adoption, and how they can be adapted and scaled sustainably.
Convinced that primary care is key to the diagnosis and monitoring of hypertension, we have evaluated multicomponent interventions, highlighting the role of community health workers, which demonstrated significant improvements in blood pressure control in vulnerable populations. Furthermore, during the pandemic, we explored strategies for monitoring therapeutic adherence based on tracking medication refills at pharmacies.
We are currently conducting a project with Harvard University involving approximately 1000 people at high cardiovascular risk. A digital application supports healthcare teams with personalized, risk-based recommendations aligned with current clinical practice guidelines. This approach allows us to help bridge the gap between what we know works and what actually happens in practice, contributing to the development of more effective, equitable, and people-centered healthcare systems.
The initiative HEARTS in the Americas, promoted by the Pan American Health Organization (PAHO), also proposes a paradigm shift in the approach to hypertension and cardiovascular risk, focused on strengthening the first level of care, standardizing evidence-based practices and teamwork at the primary care level.
From our department, we actively support this agenda through the generation of evidence and the development of implementation frameworks that promote care based on interdisciplinary teams, with clearly defined roles and coordinated participation.
Prioritizing effective implementation, strengthening primary care, clearly defining which indicators to measure and how to do so, and reducing access gaps are essential steps if we want to improve the diagnosis, management, and follow-up of people with hypertension. More than developing new therapeutic approaches, the greatest impact will be achieved by effectively addressing the barriers already identified, ensuring that the benefits reach all those who need them in a timely and equitable manner.
*Coordinator and Director of the Department of Research in Chronic Diseases at IECS