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The version of the protocol as reflected in this publication was approved by the University of Michigan IRB on April 16, 2026. An earlier version had been approved in January 2025 to support the corresponding grant application to the National Institutes of Health. Human subjects procedures use verbal informed consent.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors used Anthropic Claude Opus 4.7 (claude.ai) as an iterative writing and copyediting tool. No figures or wholesale text were AI-generated.","order":3,"name":"Ethics","label":"Statement on use of AI tools","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"DF and IAWC have received consultant fees from the World Health Organization. IAWC and LFA have received consultant fees from the Pan American Health Organization. RD and AIAAN are employees of the Ministry of Health of Guatemala. MDH has pending patents for heart failure polypills, has received travel support from the World Heart Federation, and has consulted for PwC Switzerland. MDH is also affiliated with The George Institute for Global Health, whose social enterprise arm, George Health Enterprises Pty Ltd, and its subsidiary George Medicines Pty Ltd have received investment funds to develop fixed-dose combinations of blood pressure-lowering drugs. The other authors declare no competing interests.","order":4,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"175"}}