Hypertension in Geneva: screening & structured follow-up

When to consider hypertension?

Blood pressure varies naturally throughout the day. Diagnosis is never based on a single reading but on repeated averages, in clinic and/or out of clinic. The physician considers the context (age, comorbidities, pregnancy, treatments, symptoms) to set personalised targets.

Why measure out of clinic (ABPM & AMT)?

• White-coat effect: high readings in clinic but normal at home.

• Masked hypertension: normal values in clinic but elevated in everyday life. ABPM (device worn for 24 h, daytime/night-time readings) and AMT (3–7 days, morning & evening) clearly improve diagnostic accuracy and the quality of follow-up.

ABPM vs self-measurement (AMT): which method, for whom?

• ABPM (24 h): useful at first assessment, when readings are discordant, if nocturnal hypertension is suspected, or when control is insufficient.

• AMT (at home): practical and low-cost for follow-up; should be performed with a validated upper-arm device and a standardised protocol. The choice is made with your doctor, according to the clinical objective.

Prepare well, measure well

• Rest for 5 minutes before the reading; avoid coffee/tobacco/exercise for 30 minutes beforehand.

• Sit with back and feet supported, arm at heart level.

• Use a cuff suited to arm circumference, placed on bare skin (not over clothing).

• Do not talk during the reading; take 2 readings 1–2 minutes apart.

• For AMT: morning & evening, several consecutive days, recording all readings.

Interpreting and deciding: a team effort

The physician calculates averages (clinic, ABPM, AMT), considers them alongside risk factors (family, metabolic, renal, smoking, sleep apnoea, etc.), and proposes an action plan combining lifestyle measures (diet, activity, sleep, alcohol, salt) and, if needed, medications. Targets and follow-up frequency are individualised.

Practical summary (tool choice)

Measurement context	Recommended tool	Main objective
In clinic	Validated upper-arm sphygmomanometer	Initial screening / follow-up
At home	AMT (morning & evening, 3–7 days)	Follow-up and titration
24 h	ABPM (MAPA/ABPM)	White-coat/masked, night-time assessment

FAQ – frequently asked questions

How often to check? It depends on context: closer at the start of management, then spaced out once targets are reached.

1. ABPM or AMT: which to choose? ABPM is the reference for distinguishing white-coat/masked hypertension and for night-time assessment; AMT is very useful for routine follow-up.

2. Which symptoms are warning signs? Unusual headaches, chest pain, breathlessness, visual disturbances, neurological signs: seek prompt medical attention.

3. Which home blood-pressure monitor? A validated upper-arm device with the correct cuff size, ideally checked in clinic.

4. Does hypertension always require treatment? Not always: it depends on readings and risk profile; the decision is medical and individualised.

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