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Authors
Flood, David
Wellmann Castellanos, Irmgardt Alicia María
Ayala, Luis Fernando
Tschida, Scott
Chary, Anita N.
Donis, Rocío
Alvarez Nufio, Ana Irina Argeli
Kilbourne, Amy M.
Watkins, David
Huffman, Mark D.
Rice, John D.
Rohloff, Peter
Ramírez-Zea, Manuel
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Article History
Received: 1 May 2026
Accepted: 2 June 2026
First Online: 11 June 2026
Declarations
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: Ethics approval has been obtained from INCAP (CIE-REV 135/2024), the Ministry of Health of Guatemala (No. 05-2024), and the University of Michigan (HUM00266370), which serves as the single IRB of record for U.S. collaborating institutions. The version of the protocol as reflected in this publication was approved by the University of Michigan IRB on April 16, 2026. An earlier version had been approved in January 2025 to support the corresponding grant application to the National Institutes of Health. Human subjects procedures use verbal informed consent.
: Not applicable.
: The authors used Anthropic Claude Opus 4.7 (claude.ai) as an iterative writing and copyediting tool. No figures or wholesale text were AI-generated.
: DF and IAWC have received consultant fees from the World Health Organization. IAWC and LFA have received consultant fees from the Pan American Health Organization. RD and AIAAN are employees of the Ministry of Health of Guatemala. MDH has pending patents for heart failure polypills, has received travel support from the World Heart Federation, and has consulted for PwC Switzerland. MDH is also affiliated with The George Institute for Global Health, whose social enterprise arm, George Health Enterprises Pty Ltd, and its subsidiary George Medicines Pty Ltd have received investment funds to develop fixed-dose combinations of blood pressure-lowering drugs. The other authors declare no competing interests.
