The management of hypertension in primary care continues to represent a significant burden on the NHS, both clinically and financially (Box 1). Recent estimates suggest that around 16 million people in the UK have hyper-tension (Blood Pressure Association 2005), which accounts for around 37 per cent of men and 34 per cent of women (Department of Health (DH) 2002). According to the World Health Organization (WHO), the global disease burden attributable to a systolic blood pressure of 115 mmHg or above is significant. It accounts for around seven million deaths each year (WHO 2005), 49 per cent of coronary heart disease cases and 62 per cent of strokes (Maryon-Davis et al 2005). A recent study showing that the burden of stroke is greater than that of heart disease highlights the significance of these figures (Rothwell et al 2005).