This study evaluated primary care hypertension management against UK quality targets and prescribing guidelines through a survey of 738 hypertensives in an urban three-partner personal list practice in April 2005. It looked at screening rates, prevalence, blood pressures of under 150/90 mmHg, measurement bias, ABCD prescribing and cost. The survey found that 94% of adults aged 25–79 years had been screened. With 738 confirmed cases, prevalence was 11.7% for all ages; 14.4% for those aged more than 16 years; and 46% in those over 65 years of age. Some 442 patients had ‘potential’ hypertension with their last blood pressure measurement being greater than 140/90 mmHg but inadequate follow-up. Blood pressure control of less than 150/90 mmHg was achieved in 83% of hypertensives with a six-fold terminal zero measurement bias. Looking at ABCD agents, 1,186 had been prescribed (1.84 per patient) costing £129,100 per annum. We believe that QOF hypertension prevalence in the practice (11.7%) and England (11.3%) is less than half the rate reported from community surveys. The practice demonstrated that QOF outcome targets are achievable by improving blood pressure targets to under 150/90 mmHg from 52% of patients in 2002 to 83% of patients by April 2005. Practice organisation, personal patient lists and quality targets were important factors in delivering successful care. Automated blood pressure measurement could eliminate observer bias. Restructuring therapy repeat instructions to include ABCD data encourages logical prescribing.