Study Design Design: Multicountry, pragmatic, cluster randomized clinical trial. Setting: 40 primary care clinics in Colombia and Jamaica. Participants: 1,706 adults with uncontrolled hypertension. Duration: 18 months, with additional follow-up at 24 months. Primary outcome: Between-group difference in systolic blood pressure change from baseline to 18 months. Treatment Approaches Intervention Group (n = 869) Single-pill combination therapy supported by: Physician and nurse training.

Health coaching. Home blood pressure monitoring. Blood pressure audits and feedback. Standard Care Group (n = 837) Monotherapy or combination therapy using guideline-recommended antihypertensive medications covered by health insurance or government programs. Key Findings Systolic blood pressure: Decreased by 19.1 mm Hg in the intervention group versus 9.0 mm Hg with standard care. Between-group difference:…