This audit exists to evaluate the incidence and management of uncontrolled and untreated hypertension at pre-assessment among an adult population prior to major orthopaedic surgery. It exists as part of a series of articles presented in this journal. The author will outline the aims and objectives of the audit and discuss its design. This will be followed by the access and sampling method and the data collection method. Thereafter, the audit standards, ethical considerations and audit findings will be discussed. Next, a change model will be outlined with discussion as to how this may be used to implement and develop changes in practice. Recommendations for practice will follow with a conclusion and reflection.