New tool helps thousands achieve better blood pressure control

A blood pressure program adopted across the University of California's six academic medical centers has effectively lowered hypertension and prevented serious disease or death for thousands of patients, according to a new study led by UC San Francisco. 

High blood pressure affects nearly half of Americans and is a leading cause of death, especially in underserved populations. It also can lead to heart disease, heart failure, stroke, kidney disease, and pregnancy complications. 

The new tool, one of very few developed for an entire health system to control hypertension, improved blood pressure control from 68.5% to nearly 74% among 90,000 patients, including 11,500 at UCSF. The study, published in BMJ Open Quality, lasted two years and ended in mid-2025. 

"This improvement amounts to about 4,860 people who now have controlled blood pressure, which translates to 72 strokes, 48 heart attacks and 38 deaths averted," said lead author Sandeep P. Kishore, MD, PhD, an internist and associate professor of medicine at UCSF who specializes in cardiometabolic health. "These are real Californians who didn't end up in an emergency room, didn't have a disability, didn't lose time with their families." 

A system-wide approach 

The new tool, called the UC Way Hypertension Medication Algorithm, follows a stepwise approach to increasing medication types and doses, while allowing clinicians to adjust treatment for individual factors and special populations, such as elderly people. It is integrated into UC's electronic health records. 

The tool was developed by multidisciplinary teams of UC Health experts, including cardiologists, internists, primary care physicians, nurses, pharmacists and data scientists. The group began meeting in 2020 to create a comprehensive strategy that emphasized medication affordability and reducing treatment variation across diverse patient populations. The UC Way tool was implemented systemwide in 2023. 

In addition to medication, study experts recommend commonsense lifestyle practices to improve blood pressure such as quitting smoking or tobacco use, limiting alcohol consumption (two drinks a day for men, one for women), limiting sodium (one teaspoon a day or less for most adults), exercising at least 150 minutes a week, losing weight if overweight (BMI greater than 25), eating a healthy diet, and regularly using at-home blood pressure monitors. 

Nearly 120 million U.S. adults have hypertension, which can damage arteries, and 37 million additional have even more serious disease. Only about half of those with hypertension control their blood pressure with medications and lifestyle changes. 

The problem is especially acute in some populations, including Black and Hispanic adults. For instance, by age 55, 75% of Black adults develop hypertension, compared with 54% of white men and 40% of white women. The UC Health tool increased hypertension control for Black patients to 67.3% from 63.4%. Disparities remained, however, which the authors said highlights the need for more targeted interventions. 

Beyond hypertension 

UC is one of the nation's largest public academic health systems with more than nine million outpatient visits annually. The UC Way program could be used by other health systems to standardize care of hypertension or adapted to treat other chronic diseases, noted Kishore. 

"Similar efforts are now underway for diabetes at UC Heath, and the approach may be tailored to other conditions in the future," he said. 

"The challenge isn't the science – we know how to control blood pressure," added Kishore. "This is all about having a system-wide focus that actually moves the needle. UC Health's experience shows that with the right infrastructure and commitment, large, complex health systems can improve blood pressure control and prevent heart attacks and strokes."