To analyse the use of ambulatory blood pressure monitoring (ABPM) in Primary Care, describing patients’ clinical characteristics by sex, the contribution of ABPM to the diagnosis of hypertension (HTN), and subsequent therapeutic changes.A retrospective cross-sectional observational study was conducted using electronic health records from the Federica Montseny Health Centre (Madrid) between 2020–2022. Sociodemographic variables, comorbidities, clinical parameters, antihypertensive treatment and follow-up after ABPM were collected. A descriptive bivariate analysis was performedA total of 166 patients were included, 57.6% were women, with a mean age of 62.7 years. Women showed a higher proportion of improved blood pressure control at one year (36% in men vs. 59% in women; p=0.003). In contrast, men exhibited higher rates of non-fatal cardiovascular disease (CVD) at 3 years (21% vs. 8%; p=0.017), diabetes (43% vs. 15%; p=0.002), previous ischemic heart disease (17% vs.1%; p<0.001), peripheral arterial disease (17% vs. 1%; p<0.001), and mortality due to target-organ damage (47.8% vs. 2.1%; p<0.001). Men also had a higher proportion of modified control at one year after ABPM (69.6% vs. 42.1%; p=0.014). Treatment changes were introduced in 59% of all patients and were more frequent among those with newly diagnosed HTN (39% vs. 15%; p<0.001).The high rate of treatment modification illustrates the clinical impact of ABPM in refining risk stratification and guiding management.The study confirms the usefulness of ABPM in Primary Care for improving the diagnosis and management of hypertension. Although men and women showed similar baseline risk profiles, women achieved greater improvement in blood pressure control at one year, while men experienced higher rates of cardiovascular events, consistent with their higher baseline risk.ABPM is an essential tool in Primary Care for confirming or ruling out HTN, optimising treatment, and identifying patients at increased cardiovascular risk.