IntroductionWe evaluated the IraPEN program, a localized adaptation of the WHO PEN initiative in Iran, with respect to cardiovascular disease and hypertension screening and management.MethodsA cross-sectional ecological study utilizing the Input-Process-Output-Outcome framework was conducted during 2020-2021. Aggregated data from non-communicable disease (NCD) facilities were collected and analyzed by urban/rural primary healthcare settings.ResultsThe study evaluated 610 NCD facilities, serving 1.8 million adults aged ≥ 30, of whom 515,488 underwent 10-year WHO/ISH CVD risk scoring and hypertension assessment, indicating coverage of 30%. Input/process showed all NCD facilities had functional blood pressure devices, 87% had POCT for measurement of glucose and cholesterol and 14% experienced medication stock-outs in the past three months. All staff received CVD risk scoring training, with 60% re-trained during the last two years. Output/outcome indicators revealed 3% of individuals were at moderate risk (CVD risk 10-19%), 0.6% at high risk (20-29%), 0.9% at very high risk (≥ 30%), and 2.7% had a prior CVD history. Prevalence of hypertension was 17%, compared with a national survey, indicating an observed-to-expected ratio of 55%. 80% of patients with hypertension received blood pressure-lowering medications, and 74% of them achieved blood pressure control; 38% of CVD patients received antiplatelet/anticoagulant therapy, and 66% of eligible patients took statins.ConclusionIraPEN demonstrated low coverage for CVD risk scoring and hypertension detection but acceptable treatment and control rates. Management of patients with CVD seems suboptimal. The WHO/ISH CVD risk scoring may lack in detecting high and very high-risk individuals.