Hypertension control
1.4 billion people have high blood pressure. The pills are cheap; only 23 percent have it controlled.
1.4B
people affected
19.2M
related deaths / yr
Why it is not solved yet
Biggest blocker
Nobody who pays for the control loop today owns enough of the future savings to justify it.
- FundFund an outcome contract paid per controlled patient-year in one health system.
- RunIf you run a payer or provider group, pilot paying for control instead of visits.
- WorkModel the downstream savings per controlled patient so a payer can price the contract.
Why, and how we know
The patient bears the cost and hassle now. The insurer or health system avoids a stroke or kidney-failure bill years later, often after the patient has moved to another payer. Prevention that works is invisible, so it is hard to price.
Wrong if: Systems that do own the downstream cost still fail to reach high control. Or systems without that ownership reach it anyway.
Found: Partly supports the claim. Kaiser Permanente is both insurer and provider, and it reached 90 percent. HEARTS reaches 60 percent in public systems with donor and government backing, which is a payer that owns the outcome. This is our inference from two cases, not a measured law; a public system that pays and still fails would weaken it.
On it: Kaiser Permanente (integrated payer and provider), WHO HEARTS with Resolve to Save Lives and Bloomberg Philanthropies, National health systems running HEARTS
Jaffe et al., JAMA 2013;310(7):699-705 (Kaiser Permanente Northern California) · PAHO, HEARTS in the Americas, 2025
Patients fall out of the loop between measurement, diagnosis, treatment, refill and follow-up.
- WorkBuild the registry and follow-up queue for one clinic network, under its clinical lead.
- RunRun a 90-day pilot in 3 to 10 clinics with a published baseline.
Why, and how we know
Each step is cheap; the chain is not. About 600 million people do not know they have it, follow-up is fragmented, and people stop a daily pill for a condition they cannot feel.
Wrong if: High-control systems turn out to differ from low-control ones mainly in drugs or patients, not in workflow.
Found: Supports the claim. Kaiser credits a patient registry, a simple protocol, single-pill combinations and follow-up visits run by staff, not a new drug.
On it: HEARTS programmes, Kaiser Permanente, Primary-care networks
WHO hypertension fact sheet, 2025 · WHO HEARTS technical package · Jaffe et al., JAMA 2013;310(7):699-705 (Kaiser Permanente Northern California)
Medicines are not reliably on the shelf.
- WorkMap who forecasts and procures hypertension medicines in one country.
Why, and how we know
Only 28 percent of low-income countries report general availability of all WHO-recommended hypertension medicines. A diagnosis without a refill is not treatment.
Wrong if: Control stays low in places where stock is reliable.
Readings are too noisy to diagnose and treat on.
Why, and how we know
Wrong cuff size, unvalidated devices and rushed technique change the classification. More readings is not more truth.
Wrong if: Programmes with ordinary measurement quality still reach high control.
Pressure keeps rising because salt is built into the food supply.
Why, and how we know
Average sodium intake is more than twice the WHO limit, mostly already in processed food. Telling individuals to eat less salt does not reach it; reformulation rules do.
Wrong if: Countries with mandatory sodium targets show no fall in population blood pressure.
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