The HEARTS initiative in the Americas, aimed at reducing cardiovascular mortality through the control of hypertension, required significant contextual adaptation for its successful implementation in Cuba. This article analyzes the organizational strategy and key innovations used to adapt the model to the national context, which enabled the program to expand from a single demonstration site (2016) to 451 primary care centers nationwide (2022). The process unfolded in three critical phases: (i) the adaptation of the HEARTS technical packages to primary health care in Cuba; ii) its adoption through a logical framework integrated with existing health policies; and iii) its institutionalization through regulatory reforms, the redesign of professional roles, and innovation in pharmaceuticals and local medical technology. A descriptive, cross-sectional study was conducted to evaluate the implementation of HEARTS in Cuba’s 451 polyclinics. The results of the HEARTS quality self-assessment in 2025 (nationwide) and in the first half of 2026 (at the demonstration site) are included. Despite severe economic constraints, the institutionalization of HEARTS within Cuba’s National Hypertension Program ensured its sustainability through governance restructuring, ongoing training, and data monitoring via the DHIS2 platform. This integration demonstrates that it is possible to implement global health policies through systematic adaptation and to expand coverage based on best practices through international technical cooperation.
