Background

General practitioners deal with most hypertension. Patients are usually sent to the hospital clinic because the blood pressure has not been controlled despite multiple drug treatment, for loss of previously good control, where it is felt that a cause for hypertension should be sought, or because of an overt cardiovascular event. The extent and tempo of investigation of the elevated pressure are determined by the clinical situation. Hypertension also presents as an incidental finding in other clinical situations and as a result is often suboptimally managed or even ignored. Attention to blood pressure is surprisingly cavalier in cardiac clinics given its importance as a risk factor. Undoubtedly, it is more difficult to deal with than the measurement of cholesterol and the reflex—albeit appropriate—prescribing of a statin in the patient with known ischaemic heart disease. In light of the cost of coronary angioplasty and bypass graft surgery, especially to the patient, it seems inappropriate not to pursue rigorously the best management of hypertension. Blood pressure recordings after myocardial infarction, revascularisation, and rest in hospital are unlikely to be representative of subsequent levels. Follow up is essential.

Even when undertaken, the …