2025 ACCMA Medical Student Scholarship Recipient: Pranay Narang November 4, 2025 Educational, General Optimizing Hypertension Care with Fixed Dose Combinations: Barriers & Opportunities Project by Pranay Narang Uncontrolled hypertension is a leading driver of ischemic heart disease, chronic kidney disease, heart failure, dementia, stroke, and pregnancy-related complications. Fixed-dose combinations (FDCs) are guideline-endorsed first-line therapies that improve blood pressure (BP) control by reducing pill burden, improving adherence, and targeting multiple pathophysiological mechanisms. Despite these benefits, FDC utilization remains low across U.S. health systems. Few studies examine the complex factors influencing FDC uptake; existing qualitative studies rarely interrogate structural barriers or formulate stakeholder-informed recommendations. This investigation aimed to address these evidence gaps by exploring the perspectives of providers, population health stakeholders, and health system executives through semi-structured interviews to identify structural and provider-level barriers to FDC utilization and formulate recommendations for health systems. Twenty-three participants engaged in hypertension care or hypertension-related population health initiatives at UC Health or a regional vertically-integrated health system were recruited and interviewed through purposive and snowball sampling. Following thematic analysis, structural barriers identified included limited exposure to FDCs early in training, entrenched monotherapy-reliant practice cultures, workflow constraints, fragmented formularies, and absent performance incentives and leadership endorsements. Provider-level perspectives and practices diverged: clinicians reported minimal use of FDCs, limited familiarity with FDCs, and concerns about dosage inflexibility and adverse effects. By contrast, pharmacists and nurse practitioners identified as major proponents of FDCs, demonstrated broad familiarity with therapeutic and cost advantages, and reframed clinicians concerns as misconceptions due to limited exposure. To improve FDC utilization across health systems, we propose: (1) integrating FDC exposure into early medical and pharmacy curricula; (2) embedding decision-support tools and SmartSets that prompt consideration of FDCs into electronic medical records; (3) expanding team-based care models to distribute responsibility for medication intensification; (4) securing leadership endorsements, novel incentive structures for primary care providers, and data tracking mechanisms; and (5) fostering normative change through champions, CME-accredited educational sessions, and socialization strategies.