ArticleBMC primary care2026
Closing the hypertension gap with ABPM: a primary care quality-improvement study.
Article in BMC primary care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundHypertension remains substantially underdiagnosed and undertreated globally, with ambulatory blood pressure monitoring (ABPM) - the gold standard for hypertension diagnosis - significantly underutilised in primary care. Nurse-led protocols offer a scalable approach to closing these gaps, yet evidence from rural Irish general practice is limited.
methodsThis retrospective paired clinical audit reviewed electronic health records of 706 adults aged ≥ 25 years with clinic systolic blood pressure ≥ 150 mmHg or a coded ICPC-2 diagnosis of hypertension at a single rural Irish general practice. In November 2019, a nurse-led clinical practice pathway based on ESH and NICE guidelines was implemented in the practice, empowering practice nurses to independently initiate ABPM referrals, deliver lifestyle counselling, and coordinate follow-up. Data were then collected pre-protocol (November 2017 to 2019) and post-protocol (November 2019 to 2022) to assess changes in HTN diagnosis and management. Paired categorical outcomes were compared using McNemar's test with Bonferroni correction; continuous outcomes were compared using the Wilcoxon signed-rank test.
resultsABPM utilisation rose by more than 10% (57.1% to 69.0%), enabling more accurate diagnosis and treatment decisions. Coded hypertension diagnoses rose from 78.9% to 83.9%, and the proportion achieving guideline-recommended BP targets improved from 37.7% to 44.1%. Antihypertensive therapy was meaningfully intensified: ACEi/ARB and calcium channel blocker prescribing increased significantly, and the mean number of medication classes rose from 1.88 to 2.18. Post-protocol analysis identified a sequence of associations linking ABPM uptake to new hypertension diagnosis (OR 6.60) and new diagnosis to antihypertensive prescribing (OR 5.45).
conclusionsA nurse-led protocol centred on ABPM as the diagnostic cornerstone was associated with significant improvements in hypertension diagnosis and treatment in a rural Irish primary care setting, sustained throughout the COVID-19 pandemic. These findings support wider evaluation of nurse-led, ABPM-integrated models as a practical approach to closing the hypertension treatment gap in primary care.
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