The investigators propose an intervention that leverages the success of Community Healthcare Workers (CHWs) and telehealth to connect patients with severe hypertension from Emergency Department (ED) to primary care resources and to coach them to adopt evidence-based, practical lifestyle solutions relevant to urban living. The investigators have proposed this intervention as "Coaching and Navigation by Community Health Workers (CHWs) through Telehealth for High-risk Hypertension: CONNECT-HTN intervention. The investigators hypothesize that participants receiving the CONNECT-HTN intervention will have a lower likelihood of experiencing a major cardiac event compared with those referred to clinic-based care.

This study is a randomized controlled trial evaluating whether telehealth-based coaching and navigation delivered by community health workers can improve cardiovascular outcomes among adults presenting to Emergency Departments (EDs) in Karachi with severe hypertension. Participants are randomly assigned either to receive a standard referral to primary care or to receive structured telephone-based navigation and behavioral coaching from trained community health workers.

The primary objective is to determine whether the CONNECT-HTN intervention reduces the rate of major adverse cardiovascular events (MACE) over the follow-up period. Secondary objectives include evaluating changes in blood pressure over time and examining patterns of follow-up in outpatient primary care. Outcome assessments are conducted by an independent team blinded to treatment assignment.

The study aims to provide evidence on the effectiveness of a scalable telehealth-supported community health worker model for improving long-term outcomes among patients with severe hypertension in low-resource urban settings.

Inclusion Criteria:

Eligible patients

• Must be over the age of 18 years
• Have an ED triage SBP > 180 and/or DBP > 110, with a repeat similar reading ≥30 minutes after triage
• May have received treatment for elevated BP, but must have no evidence of end-organ damage (acute stroke, acute coronary syndrome, acute kidney injury, or papilledema)
• May be admitted for deranged BP only with no complications, or may be stable for discharge per treating emergency physician
• Include referrals from the clinic to the ED with SBP/DBP values in the inclusion range
• Can provide informed consent. Intervention is accessible to individuals of all literacy levels
• Can receive phone calls and in-person visits. Smartphone ownership not required (intervention compatible with analog phones)

Exclusion Criteria:

Given that hypertension is defined and treated differently, we will exclude

• pregnant patients
• terminally ill patients, as well as
• those requiring admission to the hospital due to severe complications (other than deranged BP).

Anonymized Individual Patient Data (IPD) that underlies results will be submitted in a report format to NIH and published in well-reputed journals.

The data will become available at the end of trial completion when the findings are submitted to National Heart, Lung, and Blood Institute (NHLBI in the form of a detailed report.

The data will be accessible upon request to the Principal investigator for researchers who intend to learn, adapt, or replicate from our trial findings.

Randomized Controlled Trial