VOLUME 4. NUMBER 1. 2000. PSYCHOLOGY I N SPAI N 35 INTRODUCTION In Spain, as in many other Western countries, arterial hypertension (HT) represents the most frequent reason for consulting a doctor of all chronic pathologies dealt with by the primary health services (Pardell, 1984). The sociosanitary importance of HT is based fundamentally on two facts: (1) its role as a risk factor for the appea- rance of cardiovascular disorders, disorders that repre- sent the main cause of death in the developed countries (for example, the risks of congestive heart failure and cerebral ateriothrombosis are, respectively, six and ten times higher in persons with HT than in those with nor- motension; García-Vera and Sanz, 2000), and (2) its high frequency in the population (it is calculated that 20- 30% of Spain’s adult population suffers from hyperten- sion; Pardell, 1988). In 90-95% persons suffering from HT, their high blood pressure cannot be directly attributed to any organic anomaly or dysfunction. In these cases we can speak of essential hypertension, and there are sufficient data to affirm that psychological factors play an important role in its development, either through behaviours associated with certain physical factors related to HT, such as obe- sity, lack of physical exercise, alcohol abuse and the excessive consumption of salt in the diet (see Blanchard, Martin and Dubbert, 1988), or through the effects of stress on the cardiovascular system (see Stainbrook, 1988). Thus, people’s behaviour and their response to different life situations lead to increases in blood pres- sure which, as a function of individual predispositional variables, may persist over time, resulting in essential The original Spanish version of this paper has been previously published in Clínica y Salud, 1999, Vol. 10. No 1, 83-123 ........... Author’s note: Part of the content of this article constituted the pre- sentation on “Cardiovascular disorders: evaluation and cognitive- behavioural treatment of essential hypertension” delivered by the first author during the course “Contributions of clinical psychology to medical practice”, held in Avila, Spain on 2 July 1998, as part of the IX Summer School of the UNED (Spanish Open University). ........... Correspondence concerning this article should be addressed to María Paz García-Vera, Departamento de Personalidad, Evaluación y Psicología Clínica, Universidad Complutense de Madrid, Campus de Somosaguas, 28223 Madrid. E-mail: mpgve- ra@correo.cop.es Copyright 2000 by the Colegio Oficial de Psicólogos. Spain Psychology in Spain, 2000, Vol. 4. No 1, 35-54 Psychological treatment for essential hypertension (HT) currently relies on standardised guidelines for evaluation and diag- nosis used in primary health care. These guidelines allow the diagnosis of HT according to three abnormally high measu- rements of blood pressure taken in the clinic. Around 20-30% of HT-diagnosed patients do not exhibit high pressure outsi- de the clinic (isolated clinic HT), and may thus receive unnecessary treatment. A system for the evaluation and diagnosis of mild HT is suggested, based on a combination of clinic and non-clinic blood-pressure measurements. By distinguishing between sustained HT and isolated clinic HT with different levels of cardiovascular risk, this system allows more rational planning of monitoring and treatment. After reviewing its advantages and limitations, self-measurement by an automatic electronic sphygmomanometer is suggested as the best choice to obtain non-clinic blood-pressure measurements in the pri- mary health care context. El tratamiento psicológico de la hipertensión arterial (HTA) esencial descansa actualmente en los protocolos estandariza- dos de evaluación y diagnóstico seguidos en atención primaria. Con ellos se diagnostica la HTA atendiendo a tres medi- das de presión arterial anormalmente altas obtenidas en la consulta. El 20-30% de los pacientes con HTA así diagnosti- cada no muestran presiones altas fuera de la consulta (HTA clínica aislada) y pueden recibir un tratamiento innecesario. Se propone un sistema de evaluación y diagnóstico de la HTA leve basado en la combinación de medidas clínicas y no clí- nicas de presión arterial que permite programar más racionalmente las actuaciones de vigilancia y de intervención al dis- tinguir entre HTA mantenida y HTA clínica aislada con distintos niveles de riesgo cardiovascular. Tras revisar sus venta- jas y limitaciones, se sugiere que la mejor opción para obtener las medidas no clínicas en atención primaría es la auto- medición mediante un esfigmomanómetro electrónico automático. PROPOSAL FOR A SYSTEM OF ASSESSMENT AND DIAGNOSIS OF ESSENTIAL HYPERTENSION IN PRIMARY HEALTH SERVICES María Paz García-Vera, Jesús Sanz and Francisco J. Labrador Universidad Complutense de Madrid