Aim: To find out the level of knowledge, agreement with, and application of the recommendations of the European Society of Hypertension Guidelines 2003 in Spanish primary care physicians. Methods: Epidemiological, descriptive, and multicenter study conducted at primary care consulting rooms in Spain. Nonprobabilistic, convenience sampling layered by number of physicians from the different autonomous communities in the country. The physicians answered a structured survey that asked them about their knowledge, degree of agreement with, and application of the recommendations of the European Society of Hypertension Guidelines 2003 with regard to treatment of arterial hypertension, candidate patients for combined therapy, and the appropriate combinations. Results: Six hundred twenty-one physicians took part, with a mean age of 48.5±6.6 years and an average of 20.8±7.5 years’ experience. 73.3% of the physicians worked in the urban environment and 59.8% saw >40 patients/d. The level of knowledge and agreement with the recommendations was high: between 85% to 95% of the physicians were familiar and in agreement (wholly or partly) with the recommendations of the Guidelines. 30% to 40% of the physicians never or hardly ever applied them. Conclusions: Spanish primary care physicians are familiar and in agreement with the recommendations of the European Society of Hypertension Guidelines 2003, but a proportion of the physicians do not apply the guidelines.