Hypertension is the most widely treated cardiovascular risk factor, and there is clear evidence of the efficacy of treating systolic and diastolic blood pressure with existing antihypertensive agents in reducing stroke and cardiac disease. However, only about 25% of the US population has blood pressure controlled to at least 140 mm Hg systolic and 90 mm Hg diastolic. Hypertension control is a complex function of patient and physician behavior. Although poor hypertension control has historically been attributed to lack of health insurance or low utilization of available services, recently published analyses of national survey data and local physician and community samples suggest that physicians have a permissive attitude toward isolated mild systolic blood pressure elevations in the range of 140 to 160 mm Hg. The great majority of participants in health surveys report seeing a physician at least two times per year, and several investigators have documented that physicians are unlikely to increase treatment intensity for systolic elevations alone. Physician inaction toward elevated systolic blood pressure may be due to a reluctance to prescribe multiple drugs and/or lack of belief in the benefits of aggressive treatment to lower systolic blood pressure below 140 mm Hg.