•        As part of Community-Based Intervention for Control of Hypertension in Nepal (COBIN) trial, cluster RCT was conducted, where 1638 adults aged 25-65 were recruited. •        The participants belonged to three cohorts based on blood pressure, namely normotensive, pre-hypertensive, hypertensive and were allotted to either intervention or control arm. •        Female community health volunteers (FCHVs) were trained to provide counselling 4 times in a 12 month intervention period for lifestyle modification, focusing on increasing physical activity, reducing consumption of salt, reducing alcohol, avoiding smoking, and reducing stress. •        SBP was significantly lower in the intervention group compared usual care group, at the end of 12 month intervention,  in all cohorts, ranging from –4•9 mm Hg in the hypertensive cohort  to –2•3 mm lower in those with normal blood pressure. •        The same cohort was assessed after 60 months (intervention was only for 12 months) and surprisingly found that mean SBP actually increased by 10•4 mm Hg (95% CI 9•1–11•6) in the intervention group and by 6•0 mm Hg (4•6–7•5) in the usual care group. •        This study highlights the issues of limited duration interventions and its long term impact and the need for regular and timely counselling to sustain the beneficial effects of behaviour change interventions.