The Japanese Society of Hypertension published guidelines for home blood pressure (HBP) measurement in 2003 and for the management of hypertension in 2004. The objective of this study was to investigate the status of physicians' practice and awareness of HBP measurement based on the Japanese guidelines and compare the status between immediately after and 4 years after publication of the guidelines. A questionnaire survey regarding HBP was conducted among physicians who attended educational seminars on hypertension in 2004-05 and in 2007-08. This questionnaire was distributed, completed, and collected just before the start of the seminars. Of the 1966 and 2995 respondents to the 2004-05 and 2007-08 surveys, respectively, 90.2 and 94.6% recommended HBP measurement to their patients. The majority of physicians recommended use of the upper-arm cuff device, and recommendation of the number of measurements, documentation and evaluation of the measured values varied widely among physicians, both in 2004-05 and in 2007-08. About 10% of physicians showed sufficient understanding of the optimal methods for HBP measurement based on Japanese guidelines both in 2004-05 and in 2007-08. Only 21.6 and 23.9% of physicians correctly recognized the reference values of hypertension based on HBP measurement (systolic/diastolic, 135/85 mm Hg) in 2004-05 and in 2007-08, respectively. Although most Japanese physicians recognized the importance of HBP measurement, many had inadequate knowledge of HBP measurement, both in 2004-05 and in 2007-08. More aggressive promotion of HBP measurement among physicians is warranted.