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The purpose of this study was to evaluate the reasons physicians provided when the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) guidelines recommending a thiazide diuretic as a first line treatment for hypertension were not followed. A subsample of patients from a randomized controlled study who had uncontrolled blood pressure at an index visit and were not prescribed a thiazide were evaluated. Differences in groups that received any medication change or therapeutic lifestyle changes counseling and those that did not were compared. Differences in treatment were also compared for patients who received educational materials with or without telephone calls and financial incentive with a control group. The authors examined whether patients achieved blood pressure control in 12 months. The results show providers are not aggressive enough with getting blood pressure to goal and patients who are more educated about hypertension may be less likely to experience clinical inertia.