Cardiovascular disease remains a leading cause of preventable morbidity, particularly among vulnerable groups with limited access to preventive services. Real-world primary care settings often face barriers related to social, economic, and organizational factors. Vulnerable patients in this context include individuals with increased risk and restricted access to health services due to social, economic, or health-related factors.This practice-based reflection is supported by a small quality improvement audit – an internal analysis of care quality within one urban general practice in Bulgaria, aiming at improvement. Twenty-eight patients with hypertension were followed over a three-month period (who/where/when). Interventions included shared decision-making, family involvement, proactive outreach, and simplified communication strategies (what/how/why). Educational activities with general practice residents reinforced humanistic and equitable care principles. Measurable outcomes were collected from routine clinical records. Strengths included direct applicability and real-world relevance; limitations involved small sample size, single-practice setting, and limited resources. Alternative approaches, such as digital engagement, were considered but not implemented due to feasibility constraints.Patient and public involvement (PPI) in cardiovascular prevention appears rarely to have been implemented systematically in Bulgarian primary care, and published reports on PPI in this setting are limited. This experience demonstrates a novel application of PPI principles in a general practice context, integrating family engagement and resident training. Unlike most published PPI models, which are predominantly developed and implemented in hospital or research settings (tertiary care), this experience applies PPI principles in everyday real-world primary care practice.Engaging patients and families improved adherence and trust but required additional time and communication skills. Future practice could incorporate structured PPI tools and expand outreach to broader vulnerable groups. Caution is needed regarding sustainability and workload.This experience suggests that PPI can strengthen autonomy, equity, and humanistic relationships in everyday primary care while achieving measurable improvements in clinical engagement.Implementing PPI in a real-world primary care setting improved follow-up attendance (58%→76%), medication adherence (62%), and screening uptake (+24%). This approach may support more equitable cardiovascular prevention among vulnerable populations.