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If I were to compose a job description
  1. O M P Jolobe
  1. Retired Geriatrician, Didsbury, Manchester, UK;

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    Inevitably, it would be a reflection of my priorities. Having spent my career initially in general practice and, latterly, in the secondary healthcare sector, I have been left with an abiding awareness of the devastation wreaked by hypertension, the end result being stroke, heart failure, ischaemic heart disease, atrial fibrillation, and renal failure, singly and in various combinations, including acceleration of the vascular damage attributable to diabetes.

    These adverse outcomes are all potentially preventable through early recognition of hypertension, and through rigorous pursuit of optimum target blood pressures. Recognition of high blood pressure entails education of healthcare professionals in correct techniques of measurement of blood pressure and raising awareness among the management elite that clinical governance encompasses informed choice of blood pressure measuring equipment as well as its regular calibration.

    The preventive medical dimension entails education of the general public about dietary health hazards posed by overeating and also by the high salt content of some processed foods. Members of the public should also feel empowered, as of right, to have their blood pressures checked as a matter of routine, in primary as well as in secondary care, irrespective of the reason for the medical consultation, and to have hypertension treated to the optimum target blood pressure. Furthermore should that goal be initially unattainable, it should be an inalienable right for each and every patient to be referred to a blood pressure specialist to have his treatment optimised.

    In primary as well as in secondary care management of high blood pressure should be underpinned by audit, encompassing calibration of equipment, technique of blood pressure measurement, lifestyle education of patients, attainment of optimum target blood pressures, referral procedures for refractory hypertension, and diagnostic yield of investigative procedures for suspected secondary hypertension.

    For all these reasons it is my firm belief that all NHS trusts would benefit from the services of a specialist whose principal responsibility would be to cover the topics I have enumerated.