The RAMBLER study: the role of ambulatory blood pressure measurement in routine clinical practice: a cross-sectional study.

Ambulatory blood pressure measurement (ABPM) is a useful and important way of guiding clinical decisions in the diagnosis and treatment of hypertension. There has been little research on how ABPM is actually used in the community where hypertension is mainly diagnosed and managed. We aimed to review the use of ABPM in daily community practice in terms of patient demographics, changes in pharmaceutical treatment and the proportion of patients achieving recommended levels. Six practices using the dabI device for ABPM participated in this cross-sectional study. Patients who had the ABPM performed over the preceding 12 months were included. We recorded demographic details, pre- and post-ABPM clinic blood pressure measurements, the ABPM result and treatment before and after the test. 381 patients were included in the study, of whom 38.6% were male. The mean age was 58 years (SD= 14) and 46.7% were GMS eligible. 33.8%/ had a normal BP result on ABPM. There was a statistically significant reduction in both the mean systolic pressure(10.4 mmHg, CI 7.2-12.9, P<0.001) and diastolic pressure (5.1 mmHg, CI 3.2-6.6, P< 0.05) between the pre and the post-ABPM clinic measurements. It was found that 38.1% had a change in their medication after the test, with 31.7% having a new medication started. This pragmatic study provides information about the use of ABPM in routine general practice in Ireland. ABPM readings appear to have an impact on General Practitioners' decision- making and on the medical management of hypertensive patients in the community.