Prevention and treatment of hypertension and target organ disease remain important public health challenges which must be addressed (SIGN 2001). There is sound evidence that control of hypertension can significantly reduce the incidence of stroke and cardiac events (Mulrow and Pignone 2001). National guidelines for the identification and treatment of hypertension have been issued (Ramsey et al 1999, SIGN 2001) and a local version of the national guidelines has been issued to all GPs in Lothian. However, although there is evidence that most patients with hypertension are identified, many do not have their hypertension adequately controlled (Colhoun et al 1998), and GPs are reluctant to treat mild hypertension or hypertension in the elderly (Dickerson et al 1995a,b, Frijlen et al 2001).