The prevalence of hypertension in Indonesia remains high, while the proportion of patients with controlled blood pressure is still low. The Ministry of Health’s Strategic Plan 2022–2024 sets a target of 90% of hypertension patients achieving controlled blood pressure in primary health care facilities, yet in Central Jakarta, the achievement in 2024 was only 16.74%. This study was conducted in two community health centers with contrasting results: Puskesmas X (46.12%) and Puskesmas Y (2.34%). This study aimed to analyze the quality of hypertension control programs based on input, process, and output components using an open systems approach. The study employed a qualitative case study design. Data were collected through in-depth interviews, focus group discussions, observations, and document reviews between March and May 2025, involving 30 informants comprising health center staff, provincial and municipal health office representatives, community health volunteers, and patients. Thematic analysis was applied. The results showed that program quality at Puskesmas X was relatively better. Puskesmas X implemented proactive planning, faster provision of medications, regular educational innovations, joint monitoring with network partners, and routine training. Puskesmas Y carried out standard planning, medication procurement according to the annual cycle, regular internal coordination, and partial utilization of the hypertension dashboard. Although the number of human resources met the minimum standards, functional involvement was not evenly distributed in both health centers. The study indicated that the success of hypertension program implementation was not only determined by resource adequacy but also relied heavily on process quality, including responsive planning, structured organization, innovative implementation, and data-driven monitoring. The study recommends strengthening health worker capacity, harmonizing indicator definitions across institutions, optimizing digital educational media and integrated information systems, and formally designating administrative and information technology staff within program teams to improve hypertension service quality.