Hypertension.

1. Accurate measurement of blood pressure using a regularly serviced sphygmomanometer is essential. 2. Severe hypertension requires early treatment. Uncomplicated mild to moderate hypertension requires repeated blood pressure measurements up to three or four months before the diagnosis is confirmed. 3. Personal and family histories, relevant examination and investigations precede treatment. 4. Initial management should aim at reducing weight, improving diet and exercise, and stopping cigarette and excess alcohol consumption. 5. Patients with other risk factors require drug treatment at an earlier stage and at lower blood pressure levels. Essential hypertension is associated with an increased prevalence of risk factors which may need attention. 6. Treatment of asymptomatic hypertension should be considered in patients up to the age of 80. 7. First-line treatment: thiazide diuretics and beta blockers, used in the lowest effective doses, are of proven value and acceptability. The former are by far the cheapest antihypertensive drugs. 8. Second-line treatment: if thiazides and beta blockers are contra-indicated or ineffective, ACE inhibitors, calcium antagonists and alpha blockers should be used. With drugs of these classes the absence of adverse cardiovascular metabolic effects is a theoretical advantage but of uncertain magnitude. 9. Follow-up of patients with borderline levels of raised blood pressure as well as for those on treatment is essential.