Original Article Exploring New Models for Cardiovascular Risk Reduction: The Heart Outcomes Prevention and Evaluation 4 (HOPE 4) Canada Pilot Study Jon-David Schwalm, MD, MSc, FRCP, a Tara McCready, PhD, MBA, a Scott A. Lear, PhD, b Pablo Lamelas, MD, MSc, a,c Len Garis, d Hadi Musa, MHK, a Kaitey Vincent, BA, e Shofiqul Islam, PhD, a Amir Attaran, DPhil, f Martin McKee, CBE, MD, DSc, MSc, FRCP, FRCPE, FRCPI, FFPH, FMedSci, g and Salim Yusuf, MD, DPHIL, MRCP a a Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada b Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada c Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada d School of Criminology and Criminal Justice, University of the Fraser Valley, Abbotsford, British Columbia; BC Injury Research and Prevention Unit, Surrey, British Columbia, Canada e Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada f School of Epidemiology, Public Health and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada g Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom ABSTRACT Background: There is a gap between evidence and practice in the management of cardiovascular (CV) risk. Previous research indicated benefits from community-based, multi-faceted interventions to screen, diagnose, and manage CV risk in people with hypertension. Methods: The Heart Outcomes Prevention and Evaluation 4 Canada pilot study (HOPE 4) was a quasi-experimental preepost interventional study, involving one community each in Hamilton, Ontario and Surrey, British Columbia, Canada. Individuals aged 50 years with newly diagnosed or poorly controlled hypertension were included. The inter- vention was comprised of: (i) simplified diagnostic/treatment algo- rithms implemented by community health workers (firefighters in R  ESUM  E Contexte : Il existe un  ecart entre les donn ees probantes et la pratique en matière de prise en charge du risque cardiovasculaire (CV). Les r esultats d’ etudes ant erieures montrent que des interventions à volets multiples en milieu communautaire visant à d epister, à diagnostiquer et à prendre en charge le risque CV chez les personnes atteintes d’hypertension peuvent être b en efiques. M ethodologie : L’ etude pilote HOPE4 (Heart Outcomes Prevention and Evaluation 4 Canada)  etait une  etude interventionnelle quasi exp eri- mentale  evaluant des patients avant et après certaines interventions, men ee au sein de deux communaut es canadiennes, l’une situ ee à Hamilton, en Ontario et l’autre à Surrey, en Colombie-Britannique. Cardiovascular disease (CVD) affects half of all individuals during their lifetime. 1-3 Multiple modifiable risk factors contribute to its development, with hypertension the most significant. 4 Unfortunately, there are significant evidence- practice gaps in detection and management of established CVD and its risk factors everywhere. 5,6 For example, despite clear evidence for the benefits of blood pressure (BP) reduc- tion and the availability of low-cost and safe medication, 7 CJC Open 3 (2021) 267e275 Received for publication August 26, 2020. Accepted October 5, 2020. Ethics Statement: All screened participants provided written consent, and all enrolled participants provided full informed written consent. The study was approved by the Hamilton Integrated Research Ethics Board (#13-437) and the Simon Fraser University Research Ethics Board (#H15-01233). Corresponding author: Dr Jon-David Schwalm, Population Health Research Institute, Hamilton General Hospital Campus, DBCVSRI, 237 Barton Street East, Hamilton, Ontario L8L 2X2, Canada. Tel.: þ1-905-577- 1423; fax: þ1-905-577-1474. E-mail: schwalj@mcmaster.ca See page 273 for disclosure information. https://doi.org/10.1016/j.cjco.2020.10.006 2589-790X/Ó 2020 Canadian Cardiovascular Society. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/).