Trends in the hypertension care cascade under dual guideline criteria in Peru, 2014–2024: a decade of nationally representative surveys with joinpoint analysis and projections toward the WHO 2030 targets

Background Prior assessments of the hypertension care cascade in Peru have covered short periods and used a single diagnostic threshold. Objective To describe 11-year trends (2014–2024) in the hypertension care cascade under two contemporary criteria (2023 ESH and 2025 ACC/AHA), quantify socioeconomic inequalities, and project the cascade to 2030 relative to WHO HEARTS targets. Methods Repeated cross-sectional analysis of 238,738 adults (≥18 years) from the Peruvian Demographic and Family Health Survey (ENDES), 2014–2024. Hypertension was defined by ESH 2023 (≥140/90 mmHg or lifetime prior diagnosis) and ACC/AHA 2025 (≥130/80 mmHg or lifetime prior diagnosis). The cascade comprised awareness, pharmacological treatment, and control (<140/90 and <130/80 mmHg). Prevalences were age-standardized to the WHO World Standard Population. Joinpoint regression was applied to 23 time series and wealth-related inequalities were assessed with the Erreygers concentration index. Results Age-standardized ESH prevalence did not change significantly (AAPC 0.88%; p = 0.261), whereas ACC/AHA prevalence increased (AAPC 1.92%; p = 0.022), as did guideline discordance (AAPC 2.88%; p = 0.002); no joinpoints were identified. In 2024 (ESH), 53.6% of hypertensive adults were aware of their diagnosis, 60.3% of those diagnosed received treatment, and 59.0% of treated individuals achieved control <140/90 mmHg; population-level treatment and control were 32.3 and 19.1%. The Erreygers index indicated stronger pro-rich inequality for treatment than for awareness. Projected 2030 values for awareness, treatment, and control were 54.2, 33.5, and 21.0%, leaving gaps of 25.8, 30.5, and 30.2 percentage points relative to 80–80-80 targets. Conclusion Peru’s population-level hypertension care cascade showed persistent stagnation during 2014–2024. Current trends indicate the country will not achieve HEARTS 2030 targets without large-scale primary care interventions with an equity focus.