Translating Guidelines, Protocols, and Care Pathways for Hypertension Into Effective Program Implementation

Pedro Ordunez; Sonia Y Angell; Donald J DiPette; Jeffrey Brettler; Norm R C Campbell; Marc G Jaffe; Niamh Chapman; Andres Rosende; Grace Marie Ku; Esteban Londoño; Daniel José Piñeiro; Paul K Whelton

doi:10.1093/ajh/hpaf103

Translating Guidelines, Protocols, and Care Pathways for Hypertension Into Effective Program Implementation

Am J Hypertens. 2026 Jan 1;39(1):23-27. doi: 10.1093/ajh/hpaf103.

Authors

Affiliations

¹ Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, District of Columbia, USA.
² Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
³ Department of Medicine, University of South Carolina School of Medicine, Columbia, South Carolina, USA.
⁴ Southern California Permanente Medical Group, Department of Health Systems Science, Regional Hypertension Program, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA.
⁵ Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
⁶ Department of Endocrinology, The Permanente Medical Group, Kaiser San Francisco Medical Center, San Francisco, California, USA.
⁷ School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
⁸ Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
⁹ Faculty of Medicine and Surgery, Department of Gerontology, Vrije Universiteit Brussel, Brussels, Belgium.
¹⁰ Department of Medicine, University of Buenos Aires, Buenos Aires, Argentina.
¹¹ Department of Epidemiology, Tulane University Celia Scott Weatherhead School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA.

Abstract

Background: Inconsistent terminology and conceptual overlap among clinical practice guidelines, treatment protocols, and care pathways can lead to confusion in program design and implementation.

Methods: Drawing on the implementation experience of HEARTS in the Americas-the largest regional adaptation of the WHO Global HEARTS Initiative-this communication describes the characteristics, functions, and interrelationships of clinical practice guidelines, treatment protocols, and care pathways. It outlines their respective roles in development, approval, and execution to clarify their contributions to both health system organization and clinical practice.

Results: Clinical practice guidelines are composed of evidence-based recommendations grounded in rigorous scientific evaluation to support clinical decision-making. Care pathways serve as implementation tools that translate guidelines into standardized, multidisciplinary plans that organize hypertension management, facilitate task-sharing, and engage patients. Embedded within pathways, treatment protocols offer a simplified, step-by-step approach tailored to most patients, specifying a limited set of medications and dosages to ensure timely blood pressure control, reduce therapeutic inertia, and promote consistent care delivery.

Conclusions: Clarifying the distinctions and synergies among guidelines, protocols, and care pathways might enhance alignment between clinical guidance and service delivery, supporting effective implementation and scale-up of hypertension and chronic disease management programs.

Keywords: blood pressure; care pathways; clinical practice guidelines; hypertension; primary care; quality improvement; treatment protocols.

MeSH terms

Antihypertensive Agents* / therapeutic use
Blood Pressure* / drug effects
Clinical Protocols*
Critical Pathways* / standards
Evidence-Based Medicine
Humans
Hypertension* / diagnosis
Hypertension* / drug therapy
Hypertension* / physiopathology
Hypertension* / therapy
Practice Guidelines as Topic* / standards

Substances

Antihypertensive Agents