# Hypertension Control with WHO HEARTS: A Practical Guide for Kenyan Clinics > Hypertension is common, cheap to treat and badly controlled. HEARTS is the WHO approach that fixes the last part. What it asks of a clinic, and how to measure whether it is working. Source: https://www.afyaconnect.africa/resources/hypertension-control-who-hearts-kenya-clinics Last updated: 2026-10-19 Publisher: AfyaConnect HMS (Neurobyte Technologies), Nairobi, Kenya --- *Clinical · 8 min read · Updated 2026-10-19* Hypertension is common, cheap to treat and badly controlled. HEARTS is the WHO approach that fixes the last part. What it asks of a clinic, and how to measure whether it is working. Hypertension is one of the most common conditions in Kenyan outpatient departments and one of the cheapest to treat. It is also one of the worst controlled: many patients who are diagnosed and started on treatment do not have their blood pressure under control a year later. The problem is rarely the medicine. It is the system around it. **HEARTS** is the World Health Organization's technical package for cardiovascular disease management in primary care. It is designed for exactly the kind of facility that runs most hypertension care in Kenya: busy, nurse-led, short of doctors and short of time. ## The HEARTS package The name is the six modules: - **H**ealthy-lifestyle counselling - **E**vidence-based treatment protocols - **A**ccess to essential medicines and technology - **R**isk-based management of cardiovascular disease - **T**eam-based care - **S**ystems for monitoring The two that change outcomes fastest in most clinics are the protocol and the monitoring. ## One protocol, followed by everyone A HEARTS clinic uses a single, simple, stepped treatment protocol: specific medicines at specific doses, and a clear rule for what to do when blood pressure is still above target at the next visit. Which protocol matters less than that everyone follows the same one. A protocol lets a nurse intensify treatment confidently without waiting for a doctor, and it stops patients sitting on the same ineffective dose for a year. Use the protocol your county has adopted. If there is none, build one from the Kenya Essential Medicines List with your clinical lead. ## Measure blood pressure properly A single reading taken the moment a patient sits down reads high. Better practice is to let the patient rest, take more than one reading, discard the first and use the average of the rest. It sounds minor; at clinic scale it decides who is classified as controlled and who gets their treatment intensified unnecessarily. ## Monitoring: the indicators that matter The DHIS2 hypertension package, used with HEARTS, measures a clinic by a few indicators. The definitions are deliberate, so learn them precisely: - **Blood pressure controlled**: of patients registered before the last three months, the share whose most recent visit in the last three months recorded blood pressure below 140/90. - **Blood pressure not controlled**: the same group, most recent reading at or above 140/90. - **Missed visits**: patients in the same group with no visit in the last three months. They are in the denominator, which means a clinic cannot improve its control rate by losing patients. - **Lost to follow-up**: patients with no visit for twelve months. - **Quarterly cohorts**: patients registered in a quarter, and their outcome at the end of the following quarter. Two details people get wrong. Newly registered patients are excluded for their first three months, because it is unfair to count someone as uncontrolled before treatment has had a chance to work. And patients who stop coming stay in the denominator. That is the point: the indicator measures the clinic's ability to keep people in care, not just to treat the ones who come back. ## What gets a clinic moving - **A defaulter list every week**, and someone responsible for calling. - **Longer prescriptions for stable patients**, so a monthly trip is not the reason someone drops out. - **Medicine stock that never runs out** for the protocol drugs. - **Data the clinic can see**, not just a report sent away. A control rate on the wall is a target; one in a KHIS report nobody reads is not. ## Doing it in software AfyaConnect's NCD module is built to the DHIS2 hypertension package and HEARTS. Several readings per visit with the first discarded, a stepped protocol stored as editable data so the clinic follows its own, indicators calculated to the package's definitions so they reconcile with DHIS2, and defaulter lists for follow-up. See [NCD clinic software](/solutions/ncd-diabetes-hypertension-clinic-software-kenya). --- **Author:** The AfyaConnect Clinical & Product Team — Health systems and product engineering, Neurobyte Technologies The team that builds and supports AfyaConnect writes these guides. Everything here is written against software we actually ship and support in live Kenyan facilities — the SHA claims flow, the PPB controlled substances register and the eTIMS invoicing described in these guides are modules we maintain, not features we read about. Where regulation is still moving, we say so rather than guessing. - Supports 40+ healthcare facilities across Kenya and East Africa - Builds and maintains the SHA/NHIF claims, PPB register and KRA eTIMS modules described in these guides - Works to the Kenya Data Protection Act 2019 and Digital Health Act 2023 requirements for patient data Last reviewed: 2026-10-19