Hypertension is a major risk factor for premature morbidity and mortality throughout the world.1 In 2010 the prevalence of hypertension in the health survey for England was 32% in men and 29% in women.2 Hypertension is a common reason for consultation in primary care, and blood pressure is a key indicator within the UK Quality and Outcomes Framework.3 Although the “rule of halves” (half of people with hypertension are undetected, half of those detected are not treated, and in half of those treated hypertension is not controlled) was published 40 years ago,4 the problem of suboptimal control of high blood pressure remains. Reviews have identified that a structured approach to care is a key component of effective strategies to reduce blood pressure.5 6

In a linked paper (doi:10.1136/bmj.e7156), Stewart and colleagues present the findings of a large trial of structured care that used a computerised algorithm to titrate antihypertensives to target blood pressure.7 The trial was conducted in primary care, where most patients with hypertension are treated,2 …