UC Health's Hypertension Algorithm Prevents Thousands of Strokes and Heart Attacks

Nearly half of all Americans live with high blood pressure, and for many of them, the condition goes inadequately treated. It damages arteries silently, year after year, until the damage surfaces as a stroke, a heart attack, kidney failure, or sudden death. The problem is worse in some communities than others—by age fifty-five, three-quarters of Black adults have developed hypertension, compared to just over half of white men and forty percent of white women. For years, the science of controlling blood pressure has been straightforward. The challenge has always been something else: getting large, fragmented health systems to actually do it consistently, across all their patients, all the time.

In 2020, teams at the University of California's six academic medical centers began meeting to tackle this gap. Cardiologists, internists, primary care physicians, nurses, pharmacists, and data scientists worked together to design what would become the UC Way Hypertension Medication Algorithm—a stepwise tool that guides clinicians through medication choices and dosing while remaining flexible enough to account for individual circumstances and special populations like elderly patients. The tool was built into UC's electronic health records and rolled out system-wide in 2023. It was one of very few such programs ever developed for an entire health system.

The results, published in BMJ Open Quality after a two-year study that concluded in mid-2025, were substantial. Among ninety thousand patients tracked across the UC system—including eleven thousand five hundred at UCSF alone—blood pressure control improved from sixty-eight and a half percent to nearly seventy-four percent. That five-point-five-point gain translated to roughly forty-eight hundred additional patients whose blood pressure moved from uncontrolled to controlled. Sandeep Kishore, the lead author and an internist at UCSF who specializes in cardiometabolic health, put the human weight of that number plainly: the improvement prevented an estimated seventy-two strokes, forty-eight heart attacks, and thirty-eight deaths. These were real people who did not end up in an emergency room, who did not acquire a disability, who did not lose time with their families.

The algorithm itself is not revolutionary. It follows a logical progression of medication types and doses, adjusted for individual factors. What made it work was the system-wide commitment and the infrastructure to support it. The UC Way tool also emphasized medication affordability and aimed to reduce the variation in treatment that often emerges when different clinicians make different choices for similar patients. Alongside the medication protocol, the program recommended standard lifestyle interventions: quitting smoking, limiting alcohol to two drinks daily for men and one for women, keeping sodium intake to one teaspoon a day or less, exercising at least one hundred fifty minutes weekly, maintaining a healthy weight, eating well, and monitoring blood pressure at home.

The gains were not evenly distributed. For Black patients, hypertension control rose from sixty-three point four percent to sixty-seven point three percent—a meaningful improvement, but one that left disparities intact. The researchers acknowledged this gap and flagged the need for more targeted interventions in communities where the disease burden remains heaviest. The broader context underscores why: nearly one hundred twenty million American adults have hypertension, and another thirty-seven million have even more severe disease. Of all those people, only about half actually control their blood pressure through medication and lifestyle changes.

UC Health operates one of the nation's largest public academic health systems, handling more than nine million outpatient visits annually. Kishore and his colleagues believe the UC Way model could be adapted by other large health systems to standardize hypertension care or modified to address other chronic diseases. Similar efforts are already underway at UC for diabetes management, and the framework may eventually extend to other conditions. The lesson, Kishore emphasized, is not that the science is missing—clinicians have known how to control blood pressure for decades. The lesson is that large, complex organizations can move the needle when they commit to system-wide focus and build the infrastructure to support it. The challenge is organizational will, not medical knowledge.