Exercise every day. Moderate exercise can lower your risk of high blood pressure. Set some goals so you can exercise safely and work your way up to exercising at least 30 minutes a day most days of the week. Check with your doctor before starting an exercise plan if you have any health problems that are not being treated. You can find more information about exercise and physical activity at Go4Life.

Calcium channel blockers are drugs that reduce the movement of calcium into cells of the heart and vessels. This reduces the strength of heart contractions and relaxes the arteries, allowing them to remain more open, lowering blood pressure. Side effects of calcium channel blockers can include heart palpitations, dizziness, swollen ankles, and constipation. Calcium channel blockers can be taken alone or with other blood pressure medications. They should be taken with food or milk. Because of potential interactions, those taking calcium channel blockers should avoid alcohol and grapefruit juice.


If your blood pressure is elevated, your doctor may request you have more readings over the course of a few days or weeks. A hypertension diagnosis is rarely given after just one reading. Your doctor needs to see evidence of a sustained problem. That’s because your environment can contribute to increased blood pressure, such as the stress you may feel by being at the doctor’s office. Also, blood pressure levels change throughout the day.

Pulse pressure (the difference between systolic and diastolic blood pressure) is frequently increased in older people with hypertension. This can mean that systolic pressure is abnormally high, but diastolic pressure may be normal or low a condition termed isolated systolic hypertension.[59] The high pulse pressure in elderly people with hypertension or isolated systolic hypertension is explained by increased arterial stiffness, which typically accompanies aging and may be exacerbated by high blood pressure.[60]

Do not attempt to lower extremely elevated blood pressure in yourself or someone else. While the goal is to reduce blood pressure before additional complications develop, blood pressure should be reduced over the course of hours to days, depending on severity. It is important not to lower blood pressure too quickly, because rapid blood pressure reductions can cut off the supply of blood to the brain, leading to brain damage or death.
One of the most common diets recommended for those individuals who struggle with hypertension is called the DASH diet, which stands for Dietary Approaches to Stop Hypertension. The DASH diet-a low-sodium, low-fat diet that emphasizes fruits, vegetables, and grains-is the result of a study by the federal government. Compared to two control groups, one that followed a “normal” American diet and the other a traditional diet high in fruits and vegetables, people on the DASH diet reduced their blood pressure by an average of 6 points of systolic pressure and 3 points of diastolic pressure. Those people in the study who already had been diagnosed with hypertension reduced their blood pressure by 11 systolic points and 6 diastolic points. According to Fortmann, the DASH diet shows the importance of diet, especially a significant reduction in salt, to lowering blood pressure. Under the DASH diet, an individual is advised to eat no more than one-quarter teaspoon of salt per day. By comparison, the average American eats about four teaspoons of salt daily, nearly fifteen times more.
Aldosterone release: This steroid hormone is released from the adrenal cortex in response to angiotensin II or high serum potassium levels. Aldosterone stimulates sodium retention and potassium excretion by the kidneys. Since sodium is the main ion that determines the amount of fluid in the blood vessels by osmosis, aldosterone will increase fluid retention, and indirectly, arterial pressure.
*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For information on a given medication, check our Drug Information database. For more information on brand names, speak with your doctor or pharmacist.
In 2005, the stock of Avandamet was removed from the market, after inspections showed the factory where it was produced was violating good manufacturing practices.[135] The medication pair continued to be prescribed separately and Avandamet was again available by the end of that year. A generic formulation of metformin/rosiglitazone from Teva received tentative approval from the FDA and reached the market in early 2012.[136]
Unfortunately, metformin also has one of the lowest “patient adherence” rates, because of its side effects which can appear within hours of taking your first dose. While there are actually many positive qualities about this drug compared to other diabetes medications, metformin side effects can be remarkably uncomfortable, disrupting your daily life.
According to the American Diabetes Association Standards of Care, Metformin, if tolerated, is the preferred initial oral diabetes medication for Type 2 diabetes because it is the most effective. Unlike people with Type 1 diabetes, people with Type 2 diabetes make ​insulin. The problem is that they are either not making enough insulin or the insulin they do make isn't being used efficiently. Metformin is a weight neutral medication that helps the body use insulin. Weight neutral means that it is not associated with weight gain (or loss) as are many other diabetes medications.
Medications used to lower blood pressure include diuretics (e.g., hydrochlorothiazide*), beta-blockers (e.g., atenolol, metoprolol), ACE inhibitors (e.g., ramipril, enalapril, lisinopril), calcium channel blockers (e.g., nifedipine, amlodipine), angiotensin II receptor blockers (e.g., losartan, valsartan), and direct renin inhibitors (e.g., aliskiren).
If your blood pressure readings are consistently high, you and your doctor will probably discuss treatment strategies. Treatment for high blood pressure often begins with lifestyle changes such as a weight loss and exercise program as well as a low sodium diet. In fact, the AHA recommends adopting these strategies as a means of preventing the development of high blood pressure and heart disease. If these strategies are not successful in lowering your blood pressure, medications may be recommended.
If your blood pressure readings are consistently high, you and your doctor will probably discuss treatment strategies. Treatment for high blood pressure often begins with lifestyle changes such as a weight loss and exercise program as well as a low sodium diet. In fact, the AHA recommends adopting these strategies as a means of preventing the development of high blood pressure and heart disease. If these strategies are not successful in lowering your blood pressure, medications may be recommended.
Start low and go slow. When starting metformin, most people do well with starting with 500 mg at night or with dinner, and staying at this dose for a full week. At that point, a second 500-mg pill can be added in the morning. After another week, a third pill can be added to the evening dose. After one more week, a fourth pill can be added to the morning dose, so that by the end of the month, the full daily dose of 2,000 mg is being taken.
Blood pressure guidelines show the lower the blood pressure numbers the better. As long as no symptoms of trouble are present there is no one number that doctors consider being too low. The guidelines call for an individualized, risk-based approach to managing hypertension, as well as a personal consultation with a health care provider. While the new guidelines mean we are more aggressive about blood pressure control, lifestyle changes are always a part of the treatment plan. A treatment plan is agreed to by patient and provider, and includes ongoing communication to see how the patient is feeling and how their medications are working.
Preeclampsia is elevated blood pressure and the leakage of protein into the urine by the kidneys. Preeclampsia can be dangerous to both mother and baby. High blood pressure during pregnancy may lead to decreased blood flow to the placenta, placental abruption, premature delivery, or future cardiovascular disease. After the baby is born, high blood pressure during pregnancy usually returns to normal levels.

Your doctor can help you measure and track your blood pressure to confirm whether it’s too high. You may need to start taking medications if your blood pressure doesn’t improve after one month of following a healthy lifestyle, especially if you’re already at high risk for heart disease. If you’re at lower risk, your doctor may want to follow up in three to six months after you’ve adopted more healthy habits.
Fifteen natural ways to lower your blood pressure High blood pressure can damage the heart. It is common, affecting one in three people in the U.S. and 1 billion people worldwide. We describe why stress, sodium, and sugar can raise blood pressure and why berries, dark chocolate, and certain supplements may help to lower it. Learn about these factors and more here. Read now
^ Qaseem, A; Wilt, TJ; Rich, R; Humphrey, LL; Frost, J; Forciea, MA; Clinical Guidelines Committee of the American College of Physicians and the Commission on Health of the Public and Science of the American Academy of Family, Physicians. (21 March 2017). "Pharmacologic Treatment of Hypertension in Adults Aged 60 Years or Older to Higher Versus Lower Blood Pressure Targets: A Clinical Practice Guideline From the American College of Physicians and the American Academy of Family Physicians". Annals of Internal Medicine. 166 (6): 430–437. doi:10.7326/m16-1785. PMID 28135725. 

^ Jump up to: a b Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, Peters AL, Tsapas A, Wender R, Matthews DR (June 2012). "Management of hyperglycemia in type 2 diabetes: a patient-centered approach: position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)". Diabetes Care. 35 (6): 1364–79. doi:10.2337/dc12-0413. PMC 3357214. PMID 22517736.
It was withdrawn from the market in the UK and India in 2010,[140] and in New Zealand and South Africa in 2011.[141] From November 2011 until November 2013 the FDA[142] did not allow rosiglitazone or metformin/rosiglitazone to be sold without a prescription; moreover, makers were required to notify patients of the risks associated with its use, and the drug had to be purchased by mail order through specified pharmacies.[143]

Persistent hypertension is one of the risk factors for strokes, heart attacks, heart failure and arterial aneurysms, and is the leading cause of chronic kidney failure. Even moderate elevation of arterial pressure leads to shortened life expectancy. At severely high pressures, mean arterial pressures 50% or more above average, a person can expect to live no more than a few years unless appropriately treated.[40]


Studies even show that blood pressure measurements outside a doctor’s office are at least as accurate as those in the office (provided the equipment works well). If your results are high, take another reading. Try, try again. If they’re still high, see your healthcare provider and get checked out. Your doctor may order blood and urine tests or an EKG to diagnose other causes for your hypertension.

^ Qaseem A, Wilt TJ, Rich R, Humphrey LL, Frost J, Forciea MA (17 January 2017). "Pharmacologic Treatment of Hypertension in Adults Aged 60 Years or Older to Higher Versus Lower Blood Pressure Targets: A Clinical Practice Guideline From the American College of Physicians and the American Academy of Family Physicians". Annals of Internal Medicine. 166 (6): 430–437. doi:10.7326/M16-1785. PMID 28135725.
Metformin is capable of affecting the level of certain hormones in the body, especially in large doses. For instance, an overdose may lead to a reduction in the blood levels of thyroid-stimulating hormones, especially if the individual has a history of suffering from hypothyroidism. It can also cause a reduction of the blood level in testosterone and luteinizing hormones found in men.
Blood pressure is measured with a blood pressure cuff (sphygmomanometer). This may be done using a stethoscope and a cuff and gauge or by an automatic machine. It is a routine part of the physical examination and one of the vital signs often recorded for a patient visit. Other vital signs include pulse rate, respiratory rate (breathing rate), temperature, and weight.
As you get older, high blood pressure, especially isolated systolic hypertension, is more common and can increase your risk of serious health problems. Treatment, especially if you have other medical conditions, requires ongoing evaluation and discussions with your doctor to strike the best balance of reducing risks and maintaining a good quality of life.
“I went from Stage 3B, Grade 3 endometrioid adenocarcinoma, to Stage IV metastatic cancer 2 months after my surgery, right before I was about to start treatment. Had 2 infusions of TaxolCarbo, then got on the real metformin (originally entered a trial at Sloan Kettering that added metformin or a placebo to the Taxol/Carbo). I had to be on the drug or I could die since I had so many tumors in my body. After one more chemo treatment and one month on metformin, 88% of my tumors vanished (34cm was now 4cm). Took remaining 4 infusions of Taxol/Carbo and still had 2 cm of tumors. Refused additional chemo. Two months later, I was in total remission (Aug 2015). Have remained in remission since then”.

High blood pressure is more common in older people. At age 45, more men have hypertension than women. By age 65, this is reversed and more women are affected. People with diabetes have a greater risk of hypertension than those without diabetes. Having a close family member with high blood pressure also increases your risk of developing it. About 60% of all people with diabetes also have hypertension.


The findings mean that an additional 14 percent of U.S. adults, or about 30 million people, will now be diagnosed as having high blood pressure, compared with the number diagnosed before the new guidelines. This will bring the total percentage of U.S. adults with high blood pressure to 46 percent, up from 32 percent previously. [9 New Ways to Keep Your Heart Healthy]
Recurrent headaches: Headaches are fairly common among people with or without hypertension. Some people with hypertension notice changes or worsening of headaches when medications are skipped or when the blood pressure becomes higher than usual. Headaches associated with hypertension can be mild, moderate, or severe and can be of a throbbing nature. 
Your doctor can help you measure and track your blood pressure to confirm whether it’s too high. You may need to start taking medications if your blood pressure doesn’t improve after one month of following a healthy lifestyle, especially if you’re already at high risk for heart disease. If you’re at lower risk, your doctor may want to follow up in three to six months after you’ve adopted more healthy habits.
^ Xie, X; Atkins, E; Lv, J; Bennett, A; Neal, B; Ninomiya, T; Woodward, M; MacMahon, S; Turnbull, F; Hillis, GS; Chalmers, J; Mant, J; Salam, A; Rahimi, K; Perkovic, V; Rodgers, A (30 January 2016). "Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta-analysis". Lancet. 387 (10017): 435–43. doi:10.1016/S0140-6736(15)00805-3. PMID 26559744.

Metformin treatment of people at a prediabetes stage of risk for type 2 diabetes may decrease their chances of developing the disease, although intensive physical exercise and dieting work significantly better for this purpose. In a large U.S. study known as the Diabetes Prevention Program, participants were divided into groups and given either placebo, metformin, or lifestyle intervention and followed for an average of three years. 

High fever, "water pills" (diuretics such as hydrochlorothiazide), too much sweating, diarrhea, or vomiting may cause loss of too much body water (dehydration) and increase your risk of lactic acidosis. Stop taking this medication and tell your doctor right away if you have prolonged diarrhea or vomiting. Be sure to drink enough fluids to prevent dehydration unless your doctor directs you otherwise.
“[Metformin] has been considered a first-line medication in the treatment of type 2 diabetes, and it mainly acts by lowering the amount of glucose released by the liver,” says Minisha Sood, MD, an endocrinologist at Lenox Hill Hospital in New York City. “It also helps a hormone called insulin to work better by helping muscles use glucose in a more efficient manner. When insulin works better (and insulin sensitivity improves), a person’s insulin levels are lower than they would be otherwise.”

Damage to the heart muscle can also cause atrial fibrillation over time. Atrial fibrillation is an irregular heart rate that puts you at risk for stroke. High blood pressure can also tear the inner layer of the arteries, allowing buildup of scar tissue that attracts cholesterol debris and platelets (blood cells that form clots). Cholesterol build-up in damaged blood vessels is called a plaque. These plaques cause a narrowing of the arteries, which results in more work for the heart to pump adequate blood through the body.
‘White coat syndrome’ refers to elevated blood pressure due to nervousness or anxiety when clients have their blood pressure taken by a healthcare provider. This occurs in approximately 20% of clients. Key message: have the client take their blood pressure at home with an automatic home blood pressure cuff and compare the findings. Alternatively, you can ask the client to sit quietly and leave the room while an automatic cuff takes a client’s blood pressure. The automatic cuff can be programmed to take three measurements and the blood pressure documented is an average of the three readings.
As of 2014, approximately one billion adults or ~22% of the population of the world have hypertension.[137] It is slightly more frequent in men,[137] in those of low socioeconomic status,[6] and it becomes more common with age.[6] It is common in high, medium, and low income countries.[137][138] In 2004 rates of high blood pressure were highest in Africa, (30% for both sexes) and lowest in the Americas (18% for both sexes). Rates also vary markedly within regions with rates as low as 3.4% (men) and 6.8% (women) in rural India and as high as 68.9% (men) and 72.5% (women) in Poland.[139] Rates in Africa were about 45% in 2016.[140]
Activation of AMPK was required for metformin's inhibitory effect on liver glucose production.[97] AMPK is an enzyme that plays an important role in insulin signaling, whole body energy balance and the metabolism of glucose and fats.[98] AMPK Activation was required for an increase in the expression of small heterodimer partner, which in turn inhibited the expression of the hepatic gluconeogenic genes phosphoenolpyruvate carboxykinase and glucose 6-phosphatase.[99] Metformin is frequently used in research along with AICA ribonucleotide as an AMPK agonist. Mouse models in which the genes for AMPKα1 and α2 catalytic subunits (Prkaa1/2) or LKB1, an upstream kinase of AMPK, had been knocked out in hepatocytes, have raised doubts over the role of AMPK, since the effect of metformin was not abolished by loss of AMPK function.[92] The mechanism by which biguanides increase the activity of AMPK remains uncertain; however, metformin increases the concentration of cytosolic adenosine monophosphate (AMP) (as opposed to a change in total AMP or total AMP/adenosine triphosphate).[100] Increased cellular AMP has been proposed to explain the inhibition of glucagon-induced increase in cAMP and activation of PKA.[92] Metformin and other biguanides may antagonize the action of glucagon, thus reducing fasting glucose levels.[101] Metformin also induces a profound shift in the faecal microbial community profile in diabetic mice and this may contribute to its mode of action possibly through an effect on glucagon-like peptide-1 secretion.[93]
Before having surgery or any X-ray/scanning procedure using iodinated contrast, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products). You may need to stop this medication for a short time for the surgery/procedure. Ask your doctor or dentist for instructions before your surgery/procedure.
If you plan to have surgery or a radiology procedure that uses iodine contrast, you should stop taking metformin 48 hours before the procedure. These procedures can slow the removal of metformin from your body, raising your risk of lactic acidosis. You should resume taking metformin after the procedure only when your kidney function tests are normal.
Lactic acidosis almost never occurs with metformin exposure during routine medical care.[70] Rates of metformin-associated lactic acidosis is about nine per 100,000 person-years, which is similar to the background rate of lactic acidosis in the general population.[71] A systematic review concluded no data exists to definitively link metformin to lactic acidosis.[72]
The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH) classification of office blood pressure (BP)a and definitions of hypertension gradeb. The same classification is used for all ages from 16 years. a BP category is defined according to seated clinic BP and by the highest level of BP, whether systolic or diastolic. b Isolated systolic hypertension is graded 1, 2, or 3 according to systolic BP values in the ranges indicated.

^ Jump up to: a b Acierno, Mark J.; Brown, Scott; Coleman, Amanda E.; Jepson, Rosanne E.; Papich, Mark; Stepien, Rebecca L.; Syme, Harriet M. (2018-10-24). "ACVIM consensus statement: Guidelines for the identification, evaluation, and management of systemic hypertension in dogs and cats". Journal of Veterinary Internal Medicine. 32 (6): 1803–1822. doi:10.1111/jvim.15331. ISSN 1939-1676. PMC 6271319. PMID 30353952.

If elevated blood pressure levels are accompanied by diabetes, kidney disease, or cardiovascular disease, your doctor may suggest blood pressure medication as well lifestyle changes. If elevated levels are your only condition, lifestyle changes can help prevent blood pressure from rising. The following are lifestyle changes that may help lower blood pressure:
When an individual is approaching death, the systolic blood pressure will typically drop below 95mm Hg. However, this number can vary greatly as some individuals will always run low. Low blood pressure alone does not mean that death is imminent. Therefore, it is difficult to give an exact low blood pressure death range. The patient’s hospice care team will be assessing all of the patient’s symptoms in their totality, including how the patient is breathing and whether they have become unresponsive.
The FDA most recently revised its prescribing information on metformin in 2016.[59] Current advice is that metformin is contraindicated in people with 1) severe renal impairment (estimated glomerular filtration rate (eGFR) below 30 mL/min/1.73 m2); 2) known hypersensitivity to metformin; or 3) acute or chronic metabolic acidosis, including diabetic ketoacidosis, with or without coma. Warnings are also given regarding the use of metformin in less severe renal impairment, people aged 65 years old or greater, hypoxic states (e.g., acute congestive heart failure), excessive alcohol intake, hepatic impairment, concomitant use of certain drugs (e.g. carbonic anhydrase inhibitors such as topiramate), surgery and other procedures, or in people having a radiological study with administration of an iodinated contrast agent. Metformin is recommended to be temporarily discontinued before any procedure involving use of iodinated contrast agents, (such as a contrast-enhanced CT scan or angiogram) due to the increased risk of lactic acidosis resulting from impaired renal function;[60][61] metformin can be resumed after two days after contrast administration, if renal function is adequate and stable. It is recommended that all people receiving metformin should have their renal function (eGFR) measured at least annually and more frequently in those at higher risk of developing renal impairment.
For those with heart valve regurgitation, a change in its severity may be associated with a change in diastolic pressure. In a study of people with heart valve regurgitation that compared measurements 2 weeks apart for each person, there was an increased severity of aortic and mitral regurgitation when diastolic blood pressure increased, whereas when diastolic blood pressure decreased, there was a decreased severity.[43]

The pulse pressure is a consequence of the pulsatile nature of the cardiac output, i.e. the heartbeat. The magnitude of the pulse pressure is usually attributed to the interaction of the stroke volume of the heart, the compliance (ability to expand) of the arterial system—largely attributable to the aorta and large elastic arteries—and the resistance to flow in the arterial tree.[66]
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