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<h4>Background</h4> Cardiovascular diseases (CVDs) are the leading cause of mortality globally with almost a third of all annual deaths worldwide. Low- and middle-income countries (LMICs) are disproportionately highly affected covering 80% of these deaths. For CVD, hypertension (HTN) is the leading modifiable risk factor. The comparative impact of diagnostic interventions that improve either the accuracy, the reach, or the completion of HTN screening in comparison to the current standard of care has not been estimated. <h4>Methods and findings</h4> This microsimulation study estimated the impact on HTN-induced morbidity and mortality in LMICs for four different scenarios: (S1) lower HTN diagnostic accuracy; (S2) improved HTN diagnostic accuracy; (S3) better implementation strategies to reach more persons with existing tools; and, lastly, (S4) the wider use of easy-to-use tools, such as validated, automated digital blood pressure measurement devices to enhance screening completion, in comparison to the current standard of care (S0). Our hypothetical population was parametrized using nationally representative, individual-level HPACC data and the global burden of disease data. The prevalence of HTN in the population was 31% out of which 60% remained undiagnosed. We investigated how the alteration of a yearly blood pressure screening event impacts morbidity and mortality in the population over a period of 10 years. The study showed that while improving test accuracy avoids 0.6% of HTN-induced deaths over 10 years (13,856,507 [9,382,742; 17,395,833]), almost 40 million (39,650,363 [31,34,233, 49,298,921], i.e., 12.7% [9.9, 15.8]) of the HTN-induced deaths could be prevented by increasing coverage and completion of a screening event in the same time frame. Doubling the coverage only would still prevent 3,304,212 million ([2,274,664; 4,164,180], 12.1% [8.3, 15.2]) CVD events 10 years after the rollout of the program. Our study is limited by the scarce data available on HTN and CVD from LMICs. We had to pool some parameters across stratification groups, and additional information, such as dietary habits, lifestyle choice, or the blood pressure evolution, could not be considered. Nevertheless, the microsimulation enabled us to include substantial heterogeneity and stochasticity toward the different income groups and personal CVD risk scores in the model. <h4>Conclusions</h4> While it is important to consider investing in newer diagnostics for blood pressure testing to continuously improve ease of use and accuracy, more emphasis should be placed on screening completion. In a micro-simulation study, Lisa Koeppel and co-authors explore the comparative impact of interventions for addressing the diagnostic gap in hypertension screening in low- and middle-income countries. Author summary <h4>Why was this study done?</h4> Cardiovascular diseases (CVDs) are the leading cause of mortality globally, affecting low- and middle-income countries (LMICs) disproportionally highly. Hypertension (HTN) is the leading modifiable risk factor for CVDs. The diagnosis of HTN and thus the access to treatment is hampered by the necessity of at least one repeated measurement for a final diagnosis and the operator-dependent variability of blood pressure measurement. It is unclear which strategies would be the most impactful to close the diagnostic gap: more accurate, easy-to-use and/or more scalable tools or better implementation strategies to reach more persons with existing tools. <h4>What did the researchers do and find?</h4> We developed a stochastic microsimulation model that examines the impact of possible diagnostic interventions and implementation strategies on HTN-induced morbidity and mortality in LMICs. The different scenarios were applied over a period of 10 years and affected the individual risk of experiencing a CVD event. While improving test accuracy avoids only 0.6% of HTN-induced deaths over 10 years, scaling up test coverage and completion can avoid almost 40 million HTN-induced CVD events and 14 million (13.7%) related deaths. <h4>What do these findings mean?</h4> This simulation demonstrates the importance of increasing the coverage of testing for HTN and the improvement of screening completion over diagnostic accuracy of HTN testing. Strategies to narrow the diagnostic gap in HTN should put more emphasis on screening completion.