Hypertension affects up to 30% of people in certain European populations, and seriously jeopardizes their health. If properly managed, hypertension can be reduced and its effects minimized, but the question is how often this is achieved in practice. This publication reports on the results of a WHO project carried out to assess the levels and quality of the management of hypertension in selected European countries. Best known as the Hypertension Management Audit Project, it began in 1983. It looked at physicians' awareness of hypertension as reflected by how much went undiagnosed; the quality of the care given to known sufferers; the feelings of patients about their condition and the treatment they were receiving; the attitudes and knowledge of physicians; and the amount of anti- hypertensive drug prescriptions issued. It shows that the level of detection has improved over the last two decades, although technological diagnostic tests are still preferred to simpler but more relevant behavioural questions. Treatment is still not as effective as it could be. While most physicians understand the correct techniques for the management of hypertension, far fewer carry them out in practice. Thus the greatest potential for improvement in the care of hypertensive patients lies in the psychological sphere. A better understanding is needed of why patients, as consumers, are or are not happy and comply with treatment, and of why physicians, as providers, do or do not give treatment in line with their stated beliefs.