Blood pressure (BP) is controlled only in 34% of Americans with hypertension. 1 Barriers to control include patient nonadherence or inadequate access to care. New data suggest, however, that these are not the most important causes of poor BP control. Two studies found that most cases of uncontrolled hypertension occur in patients who had frequent contact with physicians. 2,3 These results suggest investigation of the premise that BP is not aggressively treated even when physicians frequently see patients with hypertension. Another study assessed reasons for poor BP control and found patient factors (adherence, patient acceptance, regimen complexity) were uncommon (9%) barriers cited by physicians or patients. 4 The primary barrier (91% of patient visits) was related to physicians who were satisfied with poorly controlled BP. As clinicians, many of us have seen patients who have difficulty with medication adherence or accessing the healthcare system. However, these recent findings suggest that physicians’ decisions and behavior may be more important factors contributing to poor BP control. New models for delivering care, such as the one described by Chabot et al. 5 in this is