Management of blood pressure in primary care

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 …