Globally, the prevalence of hypertension (HTN) among people with HIV (PWH) has increased dramatically over the last decade. In a cluster randomized trial, we evaluated the effect of a multicomponent intervention model on blood pressure (BP) control among PWH in rural Uganda. The integrated HIV/HTN trial enrolled adults (≥18-years) with HIV from 52 health centres in 26 districts of rural Southwestern Uganda. The intervention included: 1) health-worker training on integrating HTN care into HIV services, 2) promoting HTN screening and treatment among providers; 3) availing essential equipment and consumables; and 4) WhatsApp messaging for coordination. Among intervention participants with previously diagnosed HTN (defined as BP measurement >140/90mmHg), we evaluated longitudinal changes in the proportion with World Health Organization (WHO) defined control (<140/90mmHg) from trial baseline to 12-months of follow-up. We further reported the proportions that achieved BP reduction by ≥10mmHg. Of the 1200 intervention participants with HTN, 60% were female, with a median age of 49 years. At trial baseline, only 3.6% of participants had controlled BP.  After 12 months of the intervention, 36.7% had achieved control, corresponding to an absolute increase of 33.1% (95%CI: 25.3-41.0%; p<0.001). Significant improvements in BP control were observed across subgroups of age, sex and level of health centre. In addition, after 12 months, 70% of all participants had achieved at least 10mmHg reduction in their BP, including 74% of participants with baseline Grade 2 HTN (160-179/100-109 mmHg) and 79% of participants with Grade 3 HTN (≥180/110 mmHg). Among participants without WHO-level control at 12-months, 54% achieved at least 10mmHg reduction in BP. This health services intervention to integrate HTN and HIV care in rural primary care facilities improved long-term BP control by 30% and most participants with baseline Grade 2 and 3 HTN achieved >10mmHg reduction in their BP over the 12-month follow-up.