This study investigated the effect of large values of relative surface roughness on the heat transfer and pressure drop characteristics using simultaneously measured heat transfer and pressure drop data. Experiments were conducted using a horizontal circular tube with a base inner diameter of 5 mm and length of 4 m. One smooth and two rough tubes, with relative roughnesses of 0.04 and 0.11, were tested at different constant heat fluxes between Reynolds numbers of 100 and 8 500. Water was used as the test fluid and the Prandtl number varied between 3 and 7. Contrary to the trend in the Moody Chart, a significant increase in laminar friction factors with increasing surface roughness was observed. Both the friction factors and Nusselt numbers as functions of Reynolds number showed a clear upward and leftward shift with increasing surface roughness across the different flow regimes. Furthermore, the boundaries between the flow regimes were the same for the pressure drop and heat transfer results. The width of the transitional flow regime was narrower for rough tubes and had a differing trend. The quasi-turbulent and turbulent flow regimes occurred at lower Reynolds numbers for increasing roughness. When investigating the relationship between heat transfer and pressure drop, it was found that an increase in surface roughness favoured heat transfer in the quasi-turbulent flow regime. This is useful for rough tubes as the quasi-turbulent flow regime onsets early with regards to the Reynolds number in tubes with large roughnesses.