Following the issue of two new hypertension guidelines in the United Kingdom this year, we need to consider how they have been received by their main audience—primary care.1 2 Not too brightly, it seems.3 Differences in recommendations cause some irritation, but the main source of disaffection is, once again, targets. The rule of halves—part of which states that only half of patients with high blood pressure reached target blood pressure—was first described more than 30 years ago and now seems redolent of a distant golden age of success.4 With newer, more stringent targets, hypertension is controlled in only a third of our patients who receive treatment for it.5 Viewed from general practice, it seems that most articles on hypertension—including this one—begin by reminding us of our failures. But is this justified?

While plenty of strong evidence shows the benefits of lowering blood pressure, targets—and their ceaseless revision—are less evidence based. Compelling evidence has existed since at least 1990 that increasing blood pressure is …