BACKGROUND: Importance of the participation of clinical practitioners in the development of guideline is increasingly emphasized. We studied the attitude of family physicians to the guideline for hypertension management and compared it with their reported practice patterns. METHODS:We developed a guideline for hypertension management with reference to other guidelines previously published and used by WHO and health organizations in many countries. A questionnaires asking attitude to the contents of the guideline and real practice pattern was sent to 200 Korean family physicians. Response rate to the questionnaire was 27.5%. RESULTS: The agreement rate to annual blood screening in persons aged 15 and older was 87%, while the reported practice rate in most of patients was only 42%. The agreement rates to medical history taking in hypertensives were high in all items, but reported practice rate was very low. The agreement rates to physical examination in hypertensives were relatively high in all items, while reported practice rate was high only in lung and heart examination. The reported practice rate of laboratory tests were less than 60% and that of electrolyte check was only 22%. Most of the study subjects agreed with all behavior modification methods. Although 80% of the subjects agreed that diuretics or beta blocker should be used as an initial regimen, the reported practice rate was only 36 %. CONCLUSION: There observed a big difference between attitude to the guideline and reported practice pattern in this study. It showed the need to narrow the gap between them.