During my career, there has been great progress in understanding the prevalence, risks and treatment of high blood pressure (BP). In the major clinical practice guidelines, recommendations for management of hypertension are more similar than different. Despite this, traditional models of healthcare delivery have not yielded the BP reductions being advocated in clinical practice guidelines. In high income countries, control even to a systolic/diastolic BP <140/90 mm Hg is only being achieved in about 30% of adults and in middle- and low-income countries the percentage is <10%. The disconnect between scientific knowledge and practice patterns is alarming and has led to increasing interest in the application of strategies to improve treatment and control of high BP in clinical practice. Elements that have been most successful in meta-analysis include team-based care, health coaching, electronic support systems, and home BP monitoring. Recent randomized, controlled trials have employed a broader array of implementation strategies including team-based care, simple algorithms for lifestyle counseling and application of antihypertensive drug therapy, measures to ensure convenient, patient-centered delivery of care, elimination of barriers for access to effective therapies, patient engagement using home-based BP monitoring, and case management with prompt attention to deviations from the treatment plan. Trials using these types of strategies have resulted in impressive BP reductions and prevention of CVD events. Similar approaches in systems of care have also resulted in substantially improved hypertension control rates. The World Hypertension League (WHL) works closely with the World Health Organization (WHO) and other partners to implement the WHO HEARTS initiative on a worldwide basis. In the Americas alone, 27 countries have embraced the HEARTS model and developed customized clinical pathways for management of hypertension. The initial HEARTS results are promising but additional assessment is required to determine long term effectiveness and sustainability of the HEARTS initiative.