Project Summary/Abstract Despite highly effective pharmacologic and non-pharmacologic interventions to lower blood pressure, elevated blood pressure remains the leading global risk factor for early mortality. In Tanzanian communities, 28% of adults aged 35 and above have hypertension, yet only 2% are aware of their diagnosis and less than 1% are on anti-hypertensive treatment. Our long-term goal is to improve hypertension-related health outcomes in Tanzanian communities. The overall objective of this proposal is to adapt our established model of promoting community health interventions in partnership with highly respected religious leaders in order to bridge gaps in rural communities’ awareness, prevention, and control of high blood pressure. Our central hypothesis is that empowering religious leaders to engage their communities about high blood pressure will improve health behavior and reduce the average blood pressure among adults both with and without hypertension in the community. The rationale for our proposal is that even small reductions in community-wide blood pressure can sharply decrease the risk of premature cardiovascular death in that community. To test this hypothesis, we will pursue three specific aims: 1) Adapt and pilot-test our prior Religious Engagement in Health Intervention to address blood pressure in religious contexts; 2) Determine the effectiveness of this intervention on reducing mean community systolic blood pressure in a cluster randomized trial; and 3) Assess reach, effectiveness, adoption, implementation, and maintenance of this intervention for 24 months. In the first aim, we will use data from previously conducted interviews with religious leaders and community members to adapt, refine, and pilot-test our Religious Engagement in Health Intervention to address the problem of high blood pressure using the sequential ADAPT-ITT model. In the second aim, we will conduct a hybrid type I effectiveness- implementation cluster randomized trial to test the hypothesis that the intervention communities will achieve at least a 3 mmHg greater reduction in mean community systolic blood pressure than control communities. In the third aim, we will use convergent mixed methods guided by the RE-AIM framework to measure reach to religious leaders and community members, effect on community blood pressure and linkage to care, adoption by religious leaders, fidelity to the planned intervention, and maintenance of the benefit at 24 months. We will refine the intervention for dissemination and implementation in partnership with biomedical and religious leaders. The proposed research is innovative because it uses a novel approach to impact community health, it offers contextual flexibility to be adapted by religious leaders or other trusted community messengers for their own contexts, and it may be a creative way to engage men. The proposed research is significant because a community systolic blood pressure reduction of 3 mmHg is estimated ...