The optimal procedure for casual-clinic blood pressure (CBP) measurement is outlined in the 2004 Japanese guidelines. We investigated the status of physicians' practices and their awareness of CBP measurement immediately and 4 years after the publication of the guidelines using a questionnaire regarding CBP. This survey was conducted among physicians who attended educational seminars on hypertension in 2004-2005 and in 2007-2008; the questionnaire was distributed, completed and collected just before the start of the seminars. Of the 1966 respondents to the 2004-2005 survey and the 2995 respondents to the 2007-2008 survey, the proportion of physicians who answered that CBP was more important than self-measured BP at home (home BP) was less than 10% in both surveys. The proportion of physicians who used a mercury sphygmomanometer (68.1-75.5%) was higher than those who used an automatic and electronic sphygmomanometer (20.7-29.0%) in both surveys. However, the use of an automatic and electronic sphygmomanometer slightly increased from 20.7% in 2004-2005 to 29.0% in 2007-2008. Physicians who were younger or working in a hospital were less likely to measure CBP using the conditions of the guidelines. Approximately 50% of physicians correctly recognized the reference values of hypertension based on CBP measurement (systolic/diastolic, 140/90 mm Hg) in both surveys. The status of physicians' practice and awareness of CBP measurement varied by physicians' age, specialty and work place and those situations did not change over 4 years, underlying the importance of clarifying factors inherent in these situations.