Raised blood pressure is a common and quantitatively important cardiovascular risk factor. Over 50% of over 65’s in industrialised countries may be considered to have hypertension1 and 50% of people in this age group go on to die a cardiovascular death such as myocardial infarct or stroke.2 Studies have clearly demonstrated the benefit and safety of an aggressive strategy of blood pressure lowering with targets of below 140 mm Hg systolic and 90 mm Hg diastolic.3 Hypertension-induced stroke appears to be largely preventable and a significant reduction is seen in hypertension-attributable ischaemic heart disease when the above targets are achieved.4 Reaching and maintaining these targets in the majority of patients however presents a clinical challenge.