SUMMARY Despite the benefits of hormone replacement therapy (HRT) in relieving menopausal symptoms, there continues to be anxiety about its use in women who also have hypertension. To examine clinical practice in relation to HRT, especially in patients with hypertension, and to canvass opinions on potential or perceived side‐effects, the authors conducted a postal survey of HRT prescribing habits among 285 GPs, physicians and obstetricians in the West Midlands. The overall response rate to the questionnaire was 191 (66.3%): 61 clinicians reported that they would not prescribe HRT in women whose hypertension was difficult to control, but only 3 would withhold treatment if blood pressure was well controlled; 9% of physicians and 13% of gynaecologists did not routinely measure blood pressure before starting HRT or monitor BP at follow‐up (24% and 10% respectively). A proportion of GPs (20%), physicians (21%) and gynaecologists (9%) reported that in their opinion HRT raised blood pressure, and a minority in each group considered that HRT increased the risk of venous thrombosis, stroke and myocardial infarction. This study demonstrates differences among GPs, physicians and gynaecologists in the use of HRT in menopausal women with hypertension, the authors suggest that, in view of data from studies of the effects of HRT on blood pressure and the possible reduction of cardiovascular disease, these clinicians can be reassured and hypertensive women need not be denied the benefits of HRT, as long as there is careful monitoring.