BACKGROUND: Hypertension results in high morbidity and mortality. Its management is predominantly undertaken in the primary care setting. The aim of this study was to assess trends in blood pressure (BP) and hypertensive management in primary care in Australia. METHODS: A retrospective analysis of patient-based electronic medical records was conducted. Antihypertensive therapy was determined by prescription data. We identified 532 050 patients (55% women, average age 54 ± 18 years) being managed by 733 general practitioners from 286 clinics Australia-wide who had at least one visit with BP recorded between 2005 and 2010. RESULTS: Average BP did not change and men had consistently higher levels than women (132/79 vs. 127/77 mmHg, P < 0.001). At least 25% of all individuals had a visit where elevated BP more than 140/90 mmHg was recorded. Up to 50% of patients on antihypertensive therapy had a BP more than 140/90 mmHg. In any year, the odds of elevated BP more than 140/90 mmHg were three-fold to four-fold higher in treated individuals (yearly range OR 3.0-3.97; 95% CI 2.93-3.83 to 3.08-4.10). Over annual contiguous visits in 51 721 patients with BP more than 140/90 mmHg, BP decreased after two visits and then remained stable (P < 0.001) irrespective of frequency of visits or antihypertensive treatment. Individuals with more frequent visits were more likely to attain target BP less than 140/90 mmHg [OR 1.08 (three visits) to 1.29 (five visits); 95% CI range 1.03-1.38]. CONCLUSION: In the absence of any significant gains in the community control of hypertension since 2005, a more intensive approach to BP management in primary care is required to ensure more patients achieve BP targets.