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To describe the systolic and diastolic blood pressure criteria used by community physicians to: 1) establish a diagnosis of hypertension; and 2) increase dosage or change drug therapy in treated hypertensives. A multiethnic population sample of adults at or above 40 years old was surveyed, by random digit phone dialing in a major metropolitan area, regarding blood pressure measurement and hypertension awareness and treatment status. Respondents with and without known hypertension were asked to: 1) identify their health care providers; and 2) agree to sign and return a release form allowing the investigators to obtain copies of their medical records. Medical records received were abstracted in a standardized format. Medical records were obtained for 169 patients who collectively had 940 visits with 175 different providers during a consecutive 2-year period. Overall, 25% of these patients had 24-month average blood pressures of at or above 140/90 mm Hg without a diagnosis of hypertension being recorded by a physician. Over two-thirds of the undiagnosed had systolic blood pressure of 140-159 mm Hg, with diastolic pressure of less than 90 mm Hg. In persons on antihypertensive drugs (n equals 81), the average blood pressure was 147/86 mm Hg, and only 24% met the Joint National Committee-VI blood pressure goal of less than 140/90 mm Hg. A visit-level analysis indicated that when diastolic blood pressure was greater than 90 mm Hg, physicians intensified drug therapy 24% of the time, but intensification actions occurred in only 4% of visits when systolic pressure was less than 140 mm Hg and …