LESSONS LEARNED WITH AMBULATORY BLOOD-PRESSURE MONITORING - A FOCUS ON RAMIPRIL

Ambulatory blood pressure monitoring (ABPM) has been available since t he mid-1970s. Widespread use of ABPM in research settings has led to a n appreciation of its advantages and disadvantages. ABPM is a valuable research tool because of its ability to evaluate the duration and con sistency of action with new antihypertensive agents. It has also been used to exclude patients who have white-coat hypertension from pharmac otherapy. Past and current clinical studies are reviewed to illustrate the role of this technique in the development of a new angiotensin co nverting enzyme inhibitor, ramipril. The studies involve administering a single daily dose of ramipril to lower blood pressure and ABPM. Thr ee double-blinded, randomized studies and one placebo-controlled, cros sover study are reviewed. In these studies of patients with essential hypertension, once-daily ramipril controlled blood pressure, reduced s ystolic/diastolic blood pressure throughout a 24-hour period, and did not interfere with normal circadian blood pressure patterns. Lessons l earned from research suggest that ABPM will find a niche in clinical p ractice.