Management of high blood pressure is crucial, to forestall end organ damage, disability, and death and to reduce societal costs from cardiovascular disease, including stroke. Good management of high blood pressure is particularly important in general practice, where most patient care occurs. Recent clinical practice guidelines recommend that treatment aims to reduce blood pressure, aiming for specific targets, but the best way to use targets is not at all clear.  This study, led by Professor Jonathan Mant at the Primary Care Unit with colleagues  from Oxford and Birmingham, set out to determine whether setting targets in primary care would lead to lower blood pressure and compared two targets – one more intensive than the other.

The study, called PAST_BP, compared two groups of patients recruited from the ‘stroke registers’ of 106 general practices, who were randomly allocated to either an intensive blood pressure target or a standard target. Apart from the different blood pressure targets, the management of blood pressure was the same in both groups and was carried out by a practice nurse (to monitor blood pressure) and a general practitioner (responsible for modifying blood pressure treatment). General practitioners were provided with treatment protocols that reflected the national guidelines for blood pressure lowering in operation at the time of the trial.