Intended for healthcare professionals


Management of blood pressure in primary care

BMJ 2009; 338 doi: (Published 19 May 2009) Cite this as: BMJ 2009;338:b940
  1. Richard J McManus, clinical senior lecturer1,
  2. Jonathan Mant, professor2
  1. 1Primary Care Clinical Sciences, University of Birmingham, Birmingham B15 2TT
  2. 2General Practice and Primary Care Research Unit, University of Cambridge, Cambridge CB2 0SR
  1. r.j.mcmanus{at}

    New evidence raises questions about current monitoring and treatment recommendations

    Two linked studies provide new insights into the monitoring (doi:10.1136/bmj.b1492) and control (doi:10.1136/bmj.b1665) of blood pressure.1 2 In recent years, emphasis has shifted away from treating hypertension as a separate entity towards treating it in the context of the risk of cardiovascular disease.3 This shift has informed randomised controlled trials, such as the PROGRESS trial, which have looked for (and found) benefits of treating people at high risk (in this case, those with a previous stroke or transient ischaemic attack) with blood pressure lowering agents regardless of their blood pressure.4 It has also influenced guidelines that have recommended lower blood pressure treatment targets for people at higher risk of cardiovascular events.5 6 Within this new paradigm, we continue to titrate the use of antihypertensive drugs against blood pressure measurements. The two linked studies both provide data to challenge this orthodoxy.

    Hypertension is perhaps the most common form of chronic disease managed in primary care and routine review is costly. Follow-up is recommended every six to 12 months for people with controlled blood pressure, and in the United Kingdom pay for performance remuneration requires that blood pressure has …

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