OBJECTIVE: Determine current clinical practice in the treatment of mild-to-moderate uncomplicated hypertension. METHODS: Delphi panel survey of general practitioners and cardiologists in the US. First round – 11 physician responders. Second round – 10 of 11 physicians responded. Consensus reached in the second round. Questions addressed the status quo, JNC-VI guidelines, initial therapy, and second line therapy. RESULTS: Diuretics and ACE inhibitors are more frequently prescribed than other drug classes. HCTZ is the most frequently used diuretic, atenolol and metoprolol are the most frequently used beta-blockers. A variety of drugs are prescribed from ACE inhibitors, calcium channel blockers and angiotensin-II inhibitors. When a patient is given combination therapy, the second agent is typically a diuretic. Physicians generally agreed with the JNC-VI guidelines, except – 1) more drugs should be permissible as first-line therapy - seven physicians regularly consider classes other than diuretics or beta-blockers as initial therapy, 2) comorbidities are a major factor in drug choice and the guidelines do not adequately address this. Follow-up after initiating drug therapy typically occurs at one month. New therapies will generally be titrated upward once or twice (depending on the drug) before the drug is discontinued due to lack of efficacy. Once a patient’s hypertension is controlled, monitoring occurs every 3 to 4 months. It is extremely rare for a patient to fail all five drug classes. Results from a series of case studies in which physicians were asked to select the class of medication they would prescribe depending on the patient’s age, gender, initial blood pressure, and initial therapy will be presented. CONCLUSIONS: This study gives researchers insights into the differences between clinical practice and clinical guidelines in hypertension treatment.