Last year, new guidelines from the American Heart Association, the American College of Cardiology, and nine other health organizations lowered the numbers for the diagnosis of hypertension (high blood pressure) to 130/80 millimeters of mercury (mm Hg) and higher for all adults. The previous guidelines set the threshold at 140/90 mm Hg for people younger than age 65 and 150/80 mm Hg for those ages 65 and older.
Dr. Rachel Bond, associate director of the Women's Heart Health Program at Lenox Hill Hospital in New York City, who was not involved with the guidelines, said she agreed with the new updates. "I believe this will allow for earlier detection [of high blood pressure], and allow for more lifestyle modification to prevent the long-term detrimental effects of untreated high blood pressure," Bond said.
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).
But as many people know, diet and lifestyle change can often be very difficult. Medication is also an option for many people, sometimes because an individual has a difficult time achieving significant lifestyle change, and sometimes because hypertension is severe enough to mandate a combination of lifestyle change with medication. For many, treating their high blood pressure with medication can be a difficult subject-one that should always be considered under the guidance of your doctor.
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]
Metformin causes depletion of Vitamin B12, Folic Acid and CoQ10, leading to feelings of tiredness, weakness and in some cases, even anemia. If you have been feeling tired all the time and are lacking the energy to do anything, you may be missing Vitamin B12, or Folic Acid (Vitamin B9), or Coenzyme Q10 (CoQ10). These nutrients are needed to ensure that red blood cells of the right size are created in the body and cells are able to produce energy.
Diabetics often complain of unexplained pain in the legs, especially calf muscles. The heart is the most important muscle in the human body and loss of CoQ10 causes a feeling of ‘heaviness’ in the heart.  Metformin causes depletion of CoQ10, which is critical for muscle energy. One of the key vitamin-like compounds that is depleted by Metformin (Biguanides) is called Coenzyme Q10 or CoQ10. It is also called ubiquinone, from the word ubiquitous, meaning everywhere. It is needed for energy production in, literally, every muscle of the human body. Depletion of this vital compound leads to lack of energy and muscle pains. Another impact of the loss of CoQ10 on cardiac health shows itself in stubborn swelling in the legs and feet.
Enlarged heart. High blood pressure increases the amount of work for your heart. Like any heavily exercised muscle in your body, your heart grows bigger (enlarges) to handle the extra workload. The bigger your heart is, the more it demands oxygen-rich blood but the less able it is to maintain proper blood flow. As a result, you feel weak and tired and are not able to exercise or perform physical activities. Without treatment, your heart failure will only get worse.
The American Heart Association, or AHA, explains that the early symptoms of high blood pressure that people tend to think about are largely mythical. You are unlikely to notice “classic” signs such as anxiety, insomnia, or flushing in your face. You could have blood spots in your eyes due to subconjunctival hemorrhage, but dizziness itself is not among the essential symptoms of high blood pressure.
Imagine a garden hose hooked up to a spigot. When the hose is flexible and there are no kinks in it, you can turn on the water full blast and it will flow easily through the hose. But if there’s a kink in the hose, the water doesn’t flow as well beyond the kink. And the pressure inside the hose builds up behind the kink. Or imagine there is gunk inside the hose blocking the path of the water. Your arteries are a lot like that garden hose.
But what is a healthy blood pressure level? The exact range considered acceptable can vary. For those individuals with a family history of hypertension or with related complications, like chronic kidney disease, it’s even more important to stay at a low level. A blood pressure reading is composed of two numbers that measure the pressure in your arteries when the heart beats (called systolic pressure) and the pressure in your arteries between heartbeats (called diastolic pressure). A healthy blood pressure should measure below 120/80 (the numbers represent millimeters of mercury). The National Heart, Lung, and Blood Institute provides the following guidelines for understanding normal blood pressure and hypertension:
Metformin (prescribed to treat type 2 diabetes) can cause excessive gas and bloating, heartburn, headaches, a cough, muscle pain and a metallic taste in the mouth, but these side effects typically ease after a few weeks. Very rarely, metformin may cause a serious condition called lactic acidosis. Key signs include weakness, trouble breathing, abnormal heartbeat, unusual muscle pain, stomach discomfort, lightheadedness and feeling cold. You're more at risk if you have reduced kidney function, worsening congestive heart failure or are dehydrated.
The symptoms similar to symptoms of patients with hypertensive crisis are discussed in medieval Persian medical texts in the chapter of "fullness disease".[155] The symptoms include headache, heaviness in the head, sluggish movements, general redness and warm to touch feel of the body, prominent, distended and tense vessels, fullness of the pulse, distension of the skin, coloured and dense urine, loss of appetite, weak eyesight, impairment of thinking, yawning, drowsiness, vascular rupture, and hemorrhagic stroke.[156] Fullness disease was presumed to be due to an excessive amount of blood within the blood vessels.

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.
Metformin also interacts with anticholinergic medications, due to their effect on gastric motility. Anticholinergic drugs reduce gastric motility, prolonging the time drugs spend in the gastrointestinal tract. This impairment may lead to more metformin being absorbed than without the presence of an anticholinergic drug, thereby increasing the concentration of metformin in the plasma and increasing the risk for adverse effects.[91]
Why stress happens and how to manage it Stress is essential for survival; the chemicals it triggers help the body prepare to face danger and cope with difficulty. Long-term stress is linked to various health conditions and can cause physical and psychological symptoms. How is it diagnosed, what types of stress are there, and how is it treated or managed? Read now
A large fall in blood pressure upon standing (persistent systolic/diastolic blood pressure decrease of >20/10 mm Hg) is termed orthostatic hypotension (postural hypotension) and represents a failure of the body to compensate for the effect of gravity on the circulation. Standing results in an increased hydrostatic pressure in the blood vessels of the lower limbs. The consequent distension of the veins below the diaphragm (venous pooling) causes ~500 ml of blood to be relocated from the chest and upper body. This results in a rapid decrease in central blood volume and a reduction of ventricular preload which in turn reduces stroke volume, and mean arterial pressure. Normally this is compensated for by multiple mechanisms, including activation of the autonomic nervous system which increases heart rate, myocardial contractility and systemic arterial vasoconstriction to preserve blood pressure and elicits venous vasoconstriction to decrease venous compliance. Decreased venous compliance also results from an intrinsic myogenic increase in venous smooth muscle tone in response to the elevated pressure in the veins of the lower body. Other compensatory mechanisms include the veno-arteriolar axon reflex, the 'skeletal muscle pump' and 'respiratory pump'. Together these mechanisms normally stabilize blood pressure within a minute or less.[46] If these compensatory mechanisms fail and arterial pressure and blood flow decrease beyond a certain point, the perfusion of the brain becomes critically compromised (i.e., the blood supply is not sufficient), causing lightheadedness, dizziness, weakness or fainting.[47] Usually this failure of compensation is due to diseases or drugs that affect the sympathetic nervous system.[46] A similar effect is observed following the experience of excessive gravitational forces (G-loading), such as routinely experienced by aerobatic or combat pilots 'pulling Gs' where the extreme hydrostatic pressures exceed the ability of the body's compensatory mechanisms.
Levels of arterial pressure put mechanical stress on the arterial walls. Higher pressures increase heart workload and progression of unhealthy tissue growth (atheroma) that develops within the walls of arteries. The higher the pressure, the more stress that is present and the more atheroma tend to progress and the heart muscle tends to thicken, enlarge and become weaker over time.
There have been a significant number of studies on metformin’s risk of inducing lactic acidosis — a state in which lactic acid builds up in the body, which can be fatal. But the greater majority of studies concluded without any cases of lactic acidosis according to “The Phantom of Lactic Acidosis due to Metformin in Patients With Diabetes” in the American Diabetes Association’s (ADA) Diabetes Care journal.
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:

A hypertensive emergency, unlike the similar sounding hypertensive urgency, is characterized by serious, life-threatening complications. A hypertensive emergency means that the blood pressure is >180 mm Hg or the diastolic pressure is >120 mm Hg, and that end-organ damage is occurring. Signs and symptoms can include shortness of breath, anxiety, chest pain, irregular heart rate, confusion, or fainting. 
Events in early life, such as low birth weight, maternal smoking, and lack of breastfeeding may be risk factors for adult essential hypertension, although the mechanisms linking these exposures to adult hypertension remain unclear.[43] An increased rate of high blood urea has been found in untreated people with hypertension in comparison with people with normal blood pressure, although it is uncertain whether the former plays a causal role or is subsidiary to poor kidney function.[44] Average blood pressure may be higher in the winter than in the summer.[45] Periodontal disease is also associated with high blood pressure.[46]
In hypertensive emergency, there is evidence of direct damage to one or more organs.[27][28] The most affected organs include the brain, kidney, heart and lungs, producing symptoms which may include confusion, drowsiness, chest pain and breathlessness.[26] In hypertensive emergency, the blood pressure must be reduced more rapidly to stop ongoing organ damage,[26] however, there is a lack of randomized controlled trial evidence for this approach.[28]
Side effects such as diarrhea and gas are common when beginning the medication, but can often be alleviated by carefully titrating the dose upward over a period of time. Less common but possibly serious side effects may include lactic acidosis and B12 deficiency. Knowing the possible symptoms of lactic acidosis and monitoring B12 can offset most serious complications.
Observational studies demonstrate that people who maintain arterial pressures at the low end of these pressure ranges have much better long-term cardiovascular health. There is an ongoing medical debate over what is the optimal level of blood pressure to target when using drugs to lower blood pressure with hypertension, particularly in older people.[8]
Once the diagnosis of hypertension has been made, healthcare providers should attempt to identify the underlying cause based on risk factors and other symptoms, if present. Secondary hypertension is more common in preadolescent children, with most cases caused by kidney disease. Primary or essential hypertension is more common in adolescents and has multiple risk factors, including obesity and a family history of hypertension.[83] Laboratory tests can also be performed to identify possible causes of secondary hypertension, and to determine whether hypertension has caused damage to the heart, eyes, and kidneys. Additional tests for diabetes and high cholesterol levels are usually performed because these conditions are additional risk factors for the development of heart disease and may require treatment.[6]
This side effect only occurs when using the extended-release version. In this version, metformin diffuses through the capsule that contains the drug, and in many people the empty shell is not digested, passing apparently intact through the digestive tract. However, even though the pill appears intact, it’s just an empty husk; the medicine has been absorbed.
^ Jump up to: a b Brown S, Atkins C, Bagley R, Carr A, Cowgill L, Davidson M, Egner B, Elliott J, Henik R, Labato M, Littman M, Polzin D, Ross L, Snyder P, Stepien R (2007). "Guidelines for the identification, evaluation, and management of systemic hypertension in dogs and cats". Journal of Veterinary Internal Medicine. 21 (3): 542–58. PMID 17552466.

“One of the ways that people hypothesize metformin helps with weight loss is that, in some patients, it can help curb your appetite a little bit,” says Rodriguez. When your body’s insulin doesn’t respond normally, it can lead to cravings. Metformin can help stabilize insulin levels, thereby helping improve or curbing that sensation of extra hunger, she explains.
All material copyright MediResource Inc. 1996 – 2019. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/condition/getcondition/High-Blood-Pressure
Other medical organizations have issued new numbers recently. I believe that one must consider the source. Do the members of the group have an interest in seeing increased drug sales? Individuals with pharmaceutical connections often want people to start taking blood pressure medications, who really don't need them at all. For some, it is all about drug sales, not about your health.

Other medical organizations have issued new numbers recently. I believe that one must consider the source. Do the members of the group have an interest in seeing increased drug sales? Individuals with pharmaceutical connections often want people to start taking blood pressure medications, who really don't need them at all. For some, it is all about drug sales, not about your health.
Hypertension is a serious chronic disorder that can cause many harmful health effects over time. If you are an adult over the age of 20, you should have your blood pressure checked by your healthcare provide at your regular health visit. If you are over the age of 40, it's important to have your blood pressure checked annually. Remember, the reading you get from a manual machine or at the pharmacy may not be accurate.
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.
Peter, I’ve been using a blood pressure meter for nearly 30 years, so my response is based on my personal experience and information I’ve acquired over the years. First, I suggest that you take your meter to the doctor and have them check several readings of your meter against theirs. For example, If your meter consistently shows it’s 10 points lower than the doctor’s, just delete the 10 points from your meter reading (have them check both numbers so you can adjust both as necessary). Also, it’s common that many doctor’s offices take your blood pressure incorrectly (you should actually sit still for 5 minutes, with your feet on the floor and the cuff at the same level as your heart) . Some of us have”white coat” hypertension, so you may always be elevated at the doctor’s office. If you are a large man, you (and your doctor’s office) may need to use a larger cuff as the wrong size of cuff can affect your reading. Also, I spoke with customer service at one of the companies that makes many of the home & professional meters, and she told me that the automated machines are not very accurate if you have kidney disease or heart failure (I have both). Ask the doctor’s staff to always use the manual system and it will be more accurate than those noisy automatic ones.

Before measuring your blood pressure, do not smoke, drink caffeinated beverages, or exercise for at least 30 minutes before the test. Rest for at least five minutes before the measurements and sit still with your back straight and supported. Feet should be flat on the floor and not crossed. Your arm should also be supported on a flat surface like a table with the upper arm at heart level.
^ Jump up to: a b Brook RD, Appel LJ, Rubenfire M, Ogedegbe G, Bisognano JD, Elliott WJ, Fuchs FD, Hughes JW, Lackland DT, Staffileno BA, Townsend RR, Rajagopalan S, American Heart Association Professional Education Committee of the Council for High Blood Pressure Research, Council on Cardiovascular and Stroke Nursing, Council on Epidemiology and Prevention, and Council on Nutrition, Physical, Activity (Jun 2013). "Beyond medications and diet: alternative approaches to lowering blood pressure: a scientific statement from the American Heart Association". Hypertension. 61 (6): 1360–83. doi:10.1161/HYP.0b013e318293645f. PMID 23608661.
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. 

Some side effects of metformin may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

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