 Our innovative approach addresses critical organizational barriers and challenges existing approaches to achieving better BP control. This study is novel because it will: 1 be the largest study to test this model, 2 use a cluster randomized design to include many more clinics than previously used, 3 use a diverse group of clinics with broad geographic distribution, 4 include large numbers of patients from minority groups to assess potential health disparities, 5 evaluate whether the effect can be sustained long-term, 6 include standardized BP measurements rather than error-prone office BPs, 7 minimize selection bias, and 8 evaluate a passive observation group to evaluate dissemination of PPCM throughout the practice. We expect that our study will find a 6-8 mm Hg difference in systolic BP which would lead to 20-30 fewer coronary deaths and 25-40 fewer stroke deaths if applied across broadly across similar settings. 