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The aim of this audit was to determine the effectiveness of a protocol driven, nurse-led hypertension service for patients with diabetes at high risk.Data for this audit were collected prospectively on referred patients with established diabetes complications and suboptimal hypertension control. Antihypertensive agents were sequentially introduced and dose titrated according to protocol. Patients were discharged once the target systolic blood pressure (SBP) of <140mmHg was achieved or the intended sequence of drug therapy was complete.In all, 124 patients completed the full process. There were significant reductions in SBP (186±24 to 139±12mmHg, p<0.001) and diastolic blood pressure (85±13 to 67±11mmHg, p<0.001). A total of 61% achieved the target SBP of <140mmHg. There were expected increases in the number of antihypertensive agents and the number of agents used to maximum dose. Estimated coronary heart disease risk for the primary prevention group improved significantly despite non-significant changes in lipid profiles.It was concluded that a systematic approach combining a pre-set drug protocol itself and its timely implementation under adequate surveillance in a nurse-led hypertension clinic led to effective outcomes. Copyright © 2007 John Wiley & Sons.