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To address care variability and disparities in treatment, the University of California Health system developed and implemented the UC Way Hypertension Medication Algorithm across six academic health centres. This standardised, evidence-based protocol was co-developed by a team of multidisciplinary experts in pharmacy, cardiology, primary care and data science, with an emphasis on medication affordability and the use of two-drug fixed dose combinations as first-line therapy. Implementation strategies included stakeholder engagement, clinician education and integration into electronic health records and routine workflows. The algorithm now informs treatment decisions for over 90000 patients with hypertension and has been associated with improvements in hypertension control. The manuscript focuses on the process of algorithm development, adaptation within a complex multi-payer environment and lessons learned in promoting standardisation, clinician uptake and health equity at scale. This model may inform similar efforts across other decentralised health systems seeking to optimise chronic disease management.<\/jats:p>","DOI":"10.1136\/bmjoq-2025-003753","type":"journal-article","created":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T14:20:16Z","timestamp":1773843616000},"page":"e003753","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Scalable treatment algorithm focused on hypertension management for the University of California"],"prefix":"10.1136","volume":"15","author":[{"given":"Sandeep P","family":"Kishore","sequence":"first","affiliation":[{"name":"Department of Medicine, University of California San Francisco, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather E","family":"Martin","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, University of California Davis Health, Sacramento, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicki","family":"Friedberg","sequence":"additional","affiliation":[{"name":"University of California Health, Oakland, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8592-1607","authenticated-orcid":false,"given":"Pranay","family":"Narang","sequence":"additional","affiliation":[{"name":"University of California Berkeley University of California San Francisco Joint Medical Program, Berkeley, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachael","family":"Sak","sequence":"additional","affiliation":[{"name":"University of California Health, Oakland, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel A","family":"Skootsky","sequence":"additional","affiliation":[{"name":"University of California Health, Oakland, California, USA"},{"name":"Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,3,18]]},"reference":[{"key":"2026031807200941000_15.1.e003753.1","unstructured":"CDC . 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Available: https:\/\/millionhearts.hhs.gov\/data-reports\/hypertension-prevalence.html [Accessed 1 Aug 2025]."},{"key":"2026031807200941000_15.1.e003753.3","doi-asserted-by":"crossref","first-page":"e143","DOI":"10.1161\/HYP.0000000000000232","article-title":"Implementation Strategies to Improve Blood Pressure Control in the United States: A Scientific Statement From the American Heart Association and American Medical Association","volume":"80","author":"Abdalla","year":"2023","journal-title":"Hypertension"},{"key":"2026031807200941000_15.1.e003753.4","unstructured":"2023 ESH hypertension guideline update: Bringing us closer together across the Pond. American College of Cardiology; 2024. 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