A secondary hypertension service was set up by the Endocrinology team in 2016 aiming to capture young hypertensive (age <30 years), refractory hypertension and hypertensive emergency to provide holistic care. A pathway was developed streaming Hypertensive emergencies to the high dependency area for intravenous treatment and hypertensive urgencies to the Ambulatory care for oral medications. All patients were linked to a secondary hypertension clinic. Staring with one clinic per month, now there are 8 clinics every month due to significant 61% increment of new referrals in 2017 and another 73% in 2018. Care was provided for a total of 215 new patients. About a third of these patients (33.95%) had a secondary cause of hypertension; Primary aldosteronism 28.76%, obstructive sleep apnoea 23.28%, male secondary hypogonadism 10.95%, renal artery stenosis 10.95%, white coat hypertension 12.32% and other causes, e.g. three Adrenal Cushings, two Acromegaly, one phaeochromocytoma, one vasculitis and three non-compliance. Our prevalence rate was similar to that reported by the European Heart journal in 2014; and in some conditions even higher. An email clinic was introduced for dose adjustment based on home blood pressure logs. This ensured patient safety, saved GP appointments and increased the capacity for new slots by reducing follow up visits. 87 admissions were avoided saving 435 bed days and £71 775. Innovative ideas, inspirational team work, supportive management, structured pathway and continued education were key to the success of setting up this unique service in our District General Hospital.