The next step needed for appropriate treatment selection is risk stratification, which is based not only on the level of blood pressure, but also on the presence of other risk factors (e.g. family history, smoking, etc.), target organ damage and coexistence of cardiovascular or renal diseases.

Patient education is the cornerstone of hypertension management. The patients should be empowered with appropriate knowledge and skills to live with the chronic disease. Hypertensive patients must have basic knowledge about the nature, consequences and treatment of the disease as well as their rights and responsibilities in terms of access to care, adherence to recommended treatment and self-management. Primary care physicians and other care professionals including nurses and psychologists should help dispel misconceptions and address patients’ concerns about the disease and its treatment, for example, fear for long-term medication use or side-effects, and emphasize the positive aspects of the disease in terms of risk awareness, adoption of a healthy lifestyle and regular surveillance by a health care team. So main topics of patients’ education (“schools for hypertesives”) should include at least: (1) definition of hypertension; (2) rules of blood pressure measurement; (3) hypertension risk factors; (4) consequences of hypertension for both individual patients and for the whole community; (5) principles of hypertension management including lifestyle interventions and pharmacological treatment.

The educational programmes for hypertensive patients become more and more important as the nonpharmacological methods of treatment of arterial hypertension form the fundamental basis for successful treatment. Current hypertension guidelines state that a number of lifestyle measures that have been shown to be capable of reducing BP. They include:

Obviously all team members should participate in patients’ education, and the role of nurses, nutrition specialists and psychologists can not be overestimated. A number of randomized clinical trials have demonstrated the significant improvement of blood pressure control with nurse- of pharmacist-led care [3, 4]. The results of such studies demonstrated a reduction in blood pressure to a maximum of 13/8 mmHg [5]. The Cochrane review authors conclude that an organized system of registration, recall and regular review allied to a vigorous stepped care approach to antihypertensive drug treatment appears the most likely way to improve the control of high BP [6]. They also have confirmed that nurse or pharmacist led care was promising, with the majority of randomized clinical trials being associated with improved blood pressure control and reduction in mean systolic and diastolic blood pressure [7].

An increased amount of investigations needed for hypertensive patient, including those aimed at detection of asymptomatic target organ damage (see Table 1), together with the shortage of time for adult primary care rise a serious dilemma. One of the possible solutions lies in delegating less complex activities from physicians to other members of the primary care team so that the whole team, not solely the physician, becomes responsible for the health of patients [8]. Margolius et al. [9] have performed a qualitative research approach to determine clinicians’ opinions on the Treat-to-Target study, an intervention to improve blood pressure control. They concluded that clinicians appreciate the presence of nonclinicians on the primary care team. In the coming era of primary care clinician shortage, clinicians can be supportive of nonprofessional team members assisting with the care of patients with hypertension. Telemedicine, defined as the use of telecommunications to provide medical information and service, or remote monitoring in patients’ homes has been offered as a plausible solution of improving ambulatory medical care. Concerning the primary healthcare system it means the integration of medical, information and communication technologies in order to provide appropriate medial consultation to the patient basing on the information received from the patients’ home. From another hand, telemedicine can be helpful in getting advice from a remote specialized medical center to primary care professionals in complicated situations. Besides delivering care to hypertensive patients telemedicine has a critical role in educating patients, in improving their adherence to both non-pharmacological and medical therapy. In some countries and communities the role of telemedicine is especially important because of its capability to solve the problem of large distances and access to medical assistance. The remote counseling helps avoiding unnecessary transportation and loss of time in the physicians’ offices and out-patient department.

Today the interest to out-of-office blood pressure monitoring is a subject of extreme practical and scientific interest among cardiologists. According to the Position Paper of the European Society of Hypertension on Ambulatory Blood Pressure monitoring (2013), ambulatory blood pressure control has a lot of advantages over office blood pressure:

According to “ESH/ESC guidelines on the management of arterial hypertension” there are following indications for out-of-office blood pressure measurement: