Bangladesh HEARTS: Lessons Learned from a National Hypertension Control Program, 2018–2026

Q: What are the key findings of this study?

The Bangladesh Hypertension Control Initiative enrolled 739,057 hypertensive patients across 320 primary care facilities and achieved a 59% blood pressure control rate (<140/90 mmHg) by May 2026.

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Hypertension (n=739057). Intervention: Bangladesh Hypertension Control Initiative (WHO-HEARTS hypertension control package) vs. Baseline program status in July 2020 (or usual care in embedded 2021-2022 quasi-experimental trial). Primary outcome: Blood pressure control (<140/90 mmHg based on BP measured in the prior three months among all enrolled patients).

Q: What does this research mean for the field?

Scaling the WHO-HEARTS hypertension control model across 320 primary healthcare facilities in Bangladesh enrolled over 739,000 patients and achieved a 59% blood pressure control rate. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Shamim Jubayer; Md. Ahsan-uz-Zaman; Syed Zakir Hossain; Mahfuzur Rahman Bhuiyan; Obehi Aimiosior; Ahmad Khairul Abrar; Rahat Iqbal Chowdhury; Md Robed Amin; Bolanle Banigbe; Reena Gupta; Andrew Edward Moran; Thomas R. Frieden; Sohel Reza Choudhury

doi:10.5334/gh.1595

October 21, 2026Global HeartOpen Access

Bangladesh HEARTS: Lessons Learned from a National Hypertension Control Program, 2018–2026

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Key result

Bangladesh Hypertension Control Initiative achieves ~59% blood pressure control across primary care facilities.

n=739,057

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Why the study?

The Bangladesh Hypertension Control Initiative was launched to improve hypertension control and prevent cardiovascular disease in Bangladesh.

Does national implementation of the WHO-HEARTS technical package via the Bangladesh Hypertension Control Initiative improve blood pressure control and retention in care among adults with hypertension in Bangladesh?

Key Points

Evaluate the implementation, scale-up, and treatment outcomes of the Bangladesh Hypertension Control Initiative using the WHO-HEARTS package across rural primary health care facilities.
Scaled the WHO-HEARTS hypertension package across primary health care facilities (Upazila Health Complexes) from 4 facilities in 2018 to 320 facilities by May 2026, reaching approximately 54 million adults (~43% coverage).
Implemented quality improvement strategies including digital tracking with the Simple application, phone call and text message appointment reminders, decentralized community clinic care, and provider training.
Enrolled 739,057 hypertensive patients by May 2026, achieving a blood pressure control rate (<140/90 mmHg) of 59%, up from 37% in July 2020.
Reduced missed follow-up visits from 53% in July 2020 to 26% by May 2026 following centralized patient call systems and automated text reminders.

Study Design

Type

Observational (n=739,057)

Multicenter

Yes

Structured PICO

Does national implementation of the WHO-HEARTS technical package via the Bangladesh Hypertension Control Initiative improve blood pressure control and retention in care among adults with hypertension in Bangladesh?

P

Population

739,057 adults aged ≥18 years with hypertension enrolled across 320 primary health care facilities (Upazila Health Complexes) in Bangladesh between October 2018 and May 2026.

I

Intervention

Bangladesh Hypertension Control Initiative (BHCI) implementing the WHO-HEARTS technical package from October 2018 to May 2026, comprising: 1) a simple, linear, drug- and dose-specific protocol starting with oral amlodipine 5 mg and adding medications every four weeks; 2) free 30-day supply of antihypertensive medicines and validated digital BP devices; 3) multidisciplinary team-based care at UHC 'NCD Corners' with task-sharing and decentralization to community clinics; 4) universal facility-based opportunistic BP screening for adults ≥18 years, lifestyle counseling, and automated SMS/telephone call reminders; and 5) longitudinal digital tracking via the Simple smartphone app and quality improvement (QI) initiatives.

O

Outcome

Blood pressure control rate, defined as BP <140/90 mmHg (<130/80 mmHg for patients with comorbidities such as diabetes, ischemic heart disease, stroke, chronic kidney disease, or high CVD risk) based on BP measured in the prior three months among all enrolled patients, evaluated through May 2026.surrogate

Main Result

Absolute Event Rate: 59% vs 37%

The Bangladesh Hypertension Control Initiative demonstrates that scaling the WHO-HEARTS package in a low- and middle-income primary care system can successfully enroll over 739,000 patients and achieve a 59% blood pressure control rate.

Limitations

Hypertension screening reaches only about 8% of adults and facilities are overcrowded
Universal opportunistic screening excludes individuals who rarely attend primary health care facilities
Repeat screening of non-hypertensive patients adds workflow inefficiencies
Frequent health care worker transfers disrupt continuity of care and protocol familiarity
Medication supply is not always demand-based, leading to early stockouts and reliance on a capacity-constrained government pharmaceutical firm
From February 2020 to April 2020, BP could not be measured for all follow-up patients due to government-implemented COVID-related lockdowns, during which patients refilled medicine without measuring their BP.
Before April 2019, patient records were maintained using paper-based records before the digital database (Simple) was introduced.
Comparative shortage of trained physicians and nurses to serve a large number of hypertensive patients, alongside the burden of long-distance travel for monthly UHC visits.

Implication

May inform national hypertension programs in other LMICs; extends real-world evidence for WHO-HEARTS scale-up.

Abstract

To improve hypertension control and prevent cardiovascular disease in Bangladesh, the National Heart Foundation of Bangladesh and Resolve to Save Lives collaborated with the Ministry of Health and Family Welfare to launch the Bangladesh Hypertension Control Initiative (BHCI). The BHCI implemented the WHO-HEARTS hypertension control package in four primary health care facilities (Upazila Health Complexes or UHCs) in 2018, then scaled up to 51 UHCs in 2021, 172 UHCs by 2024, and 320 UHCs by May 2026, covering about 54 million of 108 million adults (~43% coverage). By May 2026, the BHCI had enrolled 739,057 hypertensive patients and achieved 59% blood pressure (BP) control (<140/90 mmHg based on BP measured in the prior three months among all enrolled patients). The BHCI is a scalable model for hypertension control programs in other low- and middle-income countries. For sustained high-quality national scale-up, uninterrupted supply of medicines by the government and accurate information systems are crucial.

Discussion

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Cite This Study

Jubayer et al. (2026) conducted an observational in Hypertension (n=739,057). Bangladesh Hypertension Control Initiative (WHO-HEARTS hypertension control package) vs. Baseline program status in July 2020 (or usual care in embedded 2021-2022 quasi-experimental trial) was evaluated on Blood pressure control (<140/90 mmHg based on BP measured in the prior three months among all enrolled patients). The Bangladesh Hypertension Control Initiative enrolled 739,057 hypertensive patients across 320 primary care facilities and achieved a 59% blood pressure control rate (<140/90 mmHg) by May 2026.

synapsesocial.com/papers/6adfeb2da8f7ee114eb1820f https://doi.org/10.5334/gh.1595

Topics

Hypertension management

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Bangladesh HEARTS: Lessons Learned from a National Hypertension Control Program, 2018–2026

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Topics

Bangladesh HEARTS: Lessons Learned from a National Hypertension Control Program, 2018–2026

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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