OBJECTIVE: to analyze nursing consultations with people with systemic arterial hypertension in primary health care according to the Brazilian Guidelines for Arterial Hypertension, the stages of the Nursing Process, and clinical communication. METHOD: a cross-sectional analytical study that evaluated 29 nursing consultations performed by 13 nurses with users with arterial hypertension in four Brazilian states. The consultations were assessed using a structured checklist. The data were subjected to descriptive and bivariate analyses, using tables and graphs to characterize the sample and explore potential associations among variables. RESULTS: there was low adherence to the Nursing Process and the recommendations of the Brazilian Guidelines for Hypertension. Only 20% of the steps in the Nursing Process were fully complied with. Specifically, regarding the Guidelines, there was a lack of fundamental actions, such as blood pressure measurement, risk factor assessment, and communication of the diagnosis. CONCLUSION: there was a weakness in the application of the Nursing Process in consultations with people with hypertension. Factors such as case complexity, interruptions, high work demands, gaps in training, and the absence of structured protocols contributed to these findings.