Lessons learned with ambulatory blood pressure monitoring: a focus on ramipril

Ambulatory blood pressure monitoring (ABPM) has been available since the mid-1970s. Widespread use of ABPM in research settings has led to an appreciation of its advantages and disadvantages. ABPM is a valuable research tool because of its ability to evaluate the duration and consistency of action with new antihypertensive agents. It has also been used to exclude patients who have white-coat hypertension from pharmacotherapy. Past and current clinical studies are reviewed to illustrate the role of this technique in the development of a new angiotensin converting enzyme inhibitor, ramipril. The studies involve administering a single daily dose of ramipril to lower blood pressure and ABPM. Three double-blinded, randomized studies and one placebo-controlled, crossover study are reviewed. In these studies of patients with essential hypertension, once-daily ramipril controlled blood pressure, reduced systolic/diastolic blood pressure throughout a 24-hour period, and did not interfere with normal circadian blood pressure patterns. Lessons learned from research suggest that ABPM will find a niche in clinical practice.