PROJECT SUMMARY
Hypertension is the leading modifiable cardiovascular (CVD) risk factor, affecting 1 in 4 adults worldwide, of which
2/3rd live in low- and middle-income countries. Despite the availability of effective interventions, 46% of adults with
hypertension are undiagnosed; and only 1 in 5 who are aware of their diagnosis are adequately managed. South
Asia has one of the highest prevalence of hypertension in the world, and only less than 10% adults with
hypertension achieve blood pressure control. Patients living in urban areas at particular high risk of complications
of hypertension due to a variety of reasons including complex urban health system, loose social cohesion, stress
and limited access to physical activity and healthy food and increased exposure to pollutants. We propose a
multimodal intervention that leverages telehealth and community health workers to connect patients with severe
hypertension to primary care resources and coach them using evidence-based, practical lifestyle solutions relevant
to urban living. We call the intervention Coaching and Navigation by CHW through Telehealth for High-risk
Hypertension or CONNECT-HTN. We have three specific aims. We will first iteratively refine and finalize the
protocol for implementing the CONNECT-HTN, including establishing community and stakeholder engagement to
ensure the sustainability of this approach. We will then determine whether the use of CONNECT-HTN is effective
in reducing the rate of death and hospital admissions due to heart disease or stroke and compare it to referral to
clinic-based care. In parallel we will evaluate the implementation of our intervention using a convergent, mixed
methods study design and the Consolidated Framework for Implementation Research (CFIR). Our expectation is
that CONNECT HTN will add to the evidential basis for implementing many of the WHO Best Buys for Non-
Communicable Disease (NCD) prevention and control and will be the first study powered to measure substantive
mortality and mortality outcomes in LMICs