Who manages hypertensive patients? The primary care-hospital interface

The term hypertension is used loosely to cover the right-hand skew of the blood pressure frequency distribution. It embraces almost 20% of the population, of which the major part will fare as well with or without treatment, and a much smaller group of true patients in whom underlying causes are or will be found, the causes being mainly genetic. The role of the primary care physicians is in the initial detection of patients in both groups, and in the reduction of attributable risk by collectively pushing the blood pressure distribution to the left. The role of the specialists is effective diagnosis, prognosis, and management of the more narrowly defined hypertensive patients, to reverse their high relative risk of complications, ideally at a stage before they become at high absolute risk.