^ Saiz, Luis Carlos; Gorricho, Javier; Garjón, Javier; Celaya, Mª Concepción; Muruzábal, Lourdes; Malón, Mª del Mar; Montoya, Rodolfo; López, Antonio (2017-10-11). "Blood pressure targets for the treatment of people with hypertension and cardiovascular disease". Cochrane Database of Systematic Reviews. 10: CD010315. doi:10.1002/14651858.cd010315.pub2. PMID 29020435.
The cuff is placed around the upper arm and inflated with an air pump to a pressure that blocks the flow of blood in the main artery that travels through the arm. The arm is held at the side of the body at the level of the heart, and the pressure of the cuff is gradually released. As the pressure decreases, a health practitioner listens with a stethoscope over the artery at the front of the elbow or an electronic machine senses the pulsation. The pressure at which the practitioner (or machine) first hears a pulsation from the artery is the systolic pressure (the top number). As the cuff pressure decreases further, the pressure at which the pulsation finally stops is the diastolic pressure (the bottom number).
The table shows the most recent classification (2018) of office (or clinic) blood pressure by The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH).[9] Similar thresholds had been adopted by the American Heart Association for adults who are 18 years and older,[10] but in November 2017 the American Heart Association announced revised definitions for blood pressure categories that increased the number of people considered to have high blood pressure.[11]

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]


Each pharmacy stocks different generic and name brand medications and even the smallest chemical variance can make a big difference in how our body reacts. Try out several different brands with various manufacturers, testing out the immediate and extended release so you can find the particular medication that works best for you and causes the least amount of side effects.
When discussing blood pressure issues, the healthcare professional may ask questions about past medical history, family history, and medication use, including prescriptions, over-the-counter medications, herbal remedies, and food additives. Other questions may include lifestyle habits, including activity levels, smoking, alcohol consumption, and illegal drug use.
This is one of the most common metformin side effects that a lot of people tend to experience when medicating with metformin. Generally, it is expressed in chronic diarrhea. It is believed to be related to that fact that metformin prevents enterocytes (cells in your digestive tract) from absorbing certain nutrients, particularly carbohydrates, which results in upset GI tract. 53% of the patients medicating with metformin experience diarrhea.
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.

Anyone can develop hypotension, but certain groups of people are more likely to experience it, and there are different types. For instance, orthostatic (positional) hypotension, which occurs when you stand up after sitting or lying down, is more common in older adults. Typically, “your body has certain compensatory mechanisms to prevent your blood pressure from falling when you stand up,” explains Willie Lawrence, MD, an interventional cardiologist at Research Medical Center in Kansas City, Missouri, and a spokesperson for the American Heart Association. But, he adds, “orthostatic hypotension is a problem for some people because these reflexes that should occur, don’t occur.”
Anyone can develop hypotension, but certain groups of people are more likely to experience it, and there are different types. For instance, orthostatic (positional) hypotension, which occurs when you stand up after sitting or lying down, is more common in older adults. Typically, “your body has certain compensatory mechanisms to prevent your blood pressure from falling when you stand up,” explains Willie Lawrence, MD, an interventional cardiologist at Research Medical Center in Kansas City, Missouri, and a spokesperson for the American Heart Association. But, he adds, “orthostatic hypotension is a problem for some people because these reflexes that should occur, don’t occur.”
^ Jump up to: a b c d e f Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo Jr. JL, Jones DW, Materson BJ, Oparil S, Wright Jr. JT, Roccella EJ, et al. (December 2003). "Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure". Hypertension. Joint National Committee On Prevention. 42 (6): 1206–52. doi:10.1161/01.HYP.0000107251.49515.c2. PMID 14656957. Archived from the original on 20 May 2012. Retrieved 1 January 2012.
^ Saiz, Luis Carlos; Gorricho, Javier; Garjón, Javier; Celaya, Mª Concepción; Muruzábal, Lourdes; Malón, Mª del Mar; Montoya, Rodolfo; López, Antonio (2017-10-11). "Blood pressure targets for the treatment of people with hypertension and cardiovascular disease". Cochrane Database of Systematic Reviews. 10: CD010315. doi:10.1002/14651858.cd010315.pub2. PMID 29020435.
Headaches strike over 90% of adults each year. You may be able to wait out some and let them pass, but others may be a sign that your body is asking you to take action. There is a chance that your headache could be a symptom of high blood pressure. If there are no other causes of your headache, you should ask your healthcare provider about getting your blood pressure checked.
The new guidelines stem from the 2017 results of the Systolic Blood Pressure Intervention Trial (SPRINT), which studied more than 9,000 adults ages 50 and older who had systolic blood pressure (the top number in a reading) of 130 mm Hg or higher and at least one risk factor for cardiovascular disease. The study's aim was to find out whether treating blood pressure to lower the systolic number to 120 mm Hg or less was superior to the standard target of 140 mm Hg or less. The results found that targeting a systolic pressure of no more than 120 mm Hg reduced the chance of heart attacks, heart failure, or stroke over a three-year period.
Lactate uptake by the liver is diminished with metformin use because lactate is a substrate for hepatic gluconeogenesis, a process that metformin inhibits. In healthy individuals, this slight excess is cleared by other mechanisms (including uptake by unimpaired kidneys), and no significant elevation in blood levels of lactate occurs.[31] Given severely-impaired kidney function, clearance of metformin and lactate is reduced, increasing levels of both, and possibly causing lactic acid buildup. Because metformin decreases liver uptake of lactate, any condition that may precipitate lactic acidosis is a contraindication. Common causes include alcoholism (due to depletion of NAD+ stores), heart failure and respiratory disease (due to inadequate tissue oxygenation); the most common cause is kidney disease.[75]

The portal venous system contains veins coming from the stomach, intestine, spleen, and pancreas. These veins merge into the portal vein, which branches into smaller vessels and travel through the liver. Portal hypertension occurs when there is an increase in the blood pressure within the portal venous system. When the vessels in the liver are blocked due to liver damage, blood cannot flow properly through the liver. This causes high blood pressure in the portal system.
Everybody’s blood pressure goes up and down throughout the day. Walking to work, meditating, stressing about your Facebook feed, taking that sweet afternoon nap, and pounding a triple shot espresso all influence your blood pressure. There’s even a thing called “White Coat Hypertension” where people report higher than normal blood pressure readings due to the stress of just being in a doctor’s office with a cuff strapped to your arm. Blood pressure is a moving target. It’s not the end of the world if it spikes every now and then.
John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.
Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.
^ Mente, Andrew; O'Donnell, Martin; Rangarajan, Sumathy; Dagenais, Gilles; Lear, Scott; McQueen, Matthew; Diaz, Rafael; Avezum, Alvaro; Lopez-Jaramillo, Patricio; Lanas, Fernando; Li, Wei; Lu, Yin; Yi, Sun; Rensheng, Lei; Iqbal, Romaina; Mony, Prem; Yusuf, Rita; Yusoff, Khalid; Szuba, Andrzej; Oguz, Aytekin; Rosengren, Annika; Bahonar, Ahmad; Yusufali, Afzalhussein; Schutte, Aletta Elisabeth; Chifamba, Jephat; Mann, Johannes F E; Anand, Sonia S; Teo, Koon; Yusuf, S (July 2016). "Associations of urinary sodium excretion with cardiovascular events in individuals with and without hypertension: a pooled analysis of data from four studies". The Lancet. 388 (10043): 465–75. doi:10.1016/S0140-6736(16)30467-6. PMID 27216139.
Metformin (also known by generic name Glucophage) is an oral hypoglycemic medication used to control high blood sugar. It is used in managing Type II diabetes, in the cases when the body’s high blood sugar levels cannot be properly controlled through exercise, diet and weight management alone. In some cases, patients use Metformin along with other anti-diabetic drugs like glyburide and insulin.
So while metformin is often given to people with high insulin levels who have difficulty losing weight, it’s not a miracle weight loss solution, says Dr. Sood. In other words, don’t expect a dramatic change in weight if you overeat and lead a sedentary life. You must follow a sensible weight loss plan with healthy eating and physical activity to see any significant change in weight.
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.
Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.Information last revised July 2018. Copyright(c) 2018 First Databank, Inc. 

Metformin doesn't typically cause blood pressure to plummet and lead to hypoglycemia, but it can—and that can cause headaches. "Metformin alone should not cause hypoglycemia,” Rodriguez explains. But “when we see headaches, it’s usually in a patient on a combination of medications that can drop blood sugars too low.” If you’re experiencing an abnormal amount of headaches or an abnormal type of headache, talk to your doctor about adjusting your medications.
Metformin is prescribed for people with type 2 diabetes. Like any medication, it carries the risk of side effects. The most common side effects from metformin include nausea, diarrhea, gas and upset stomach. These are most likely when you first start taking it and usually go away on their own. Until they do, you should try to take your metformin with a meal. You can also try reducing the amount you take for a few days and gradually increasing it until you’ve reached the amount your doctor has prescribed for you.
Dietary changes can help control blood pressure. One diet designed to promote lower blood pressure is known as the DASH diet. This stands for Dietary Approaches to Stop Hypertension. The DASH diet recommends eating more vegetables, fruits, whole grains, low-fat dairy products, poultry, nuts, and fish. Red meat, saturated fats, and sweets should be avoided. The DASH diet can lower blood pressure within 2 weeks. It can also help to reduce your intake of sodium. The following is the DASH diet suggested daily intake:

A 2015 review of several studies found that restoring blood vitamin D levels by using supplements (more than 1,000 IU per day) reduced blood pressure in hypertensive individuals when they had existing vitamin D deficiency.[167] The results also demonstrated a correlation of chronically low vitamin D levels with a higher chance of becoming hypertensive. Supplementation with vitamin D over 18 months in normotensive individuals with vitamin D deficiency did not significantly affect blood pressure.[167]
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.
^ 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.
If your friend is experiencing frequent headaches and other symptoms she's attributing to high blood pressure, it might be wise for her to visit her doctor to make sure another condition isn't causing the problem. If she does have uncontrolled high blood pressure, she should also be certain to work with her doctor to manage her condition. Unchecked, high blood pressure can lead to numerous complications, including damage to your arteries, brain, heart, and kidneys.
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Some side effects 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:

1. Concentrate on foods that lower blood pressure. Sugary, processed foods contain salt, sugar, damaged fats, and food sensitivities like gluten that contribute to or exacerbate high blood pressure. Shifting to a whole, unprocessed foods diet can dramatically impact your blood pressure. Many whole, unprocessed foods are rich in potassium, a mineral that supports healthy blood pressure. Some research shows that too much sodium and low amounts of potassium – can contribute to high blood pressure. Research shows people with high blood pressure can benefit from increased potassium in foods including avocado, spinach, wild-caught salmon, and sweet potatoes.
Much of the disease burden of high blood pressure is experienced by people who are not labeled as hypertensive.[87] Consequently, population strategies are required to reduce the consequences of high blood pressure and reduce the need for antihypertensive medications. Lifestyle changes are recommended to lower blood pressure, before starting medications. The 2004 British Hypertension Society guidelines[87] proposed lifestyle changes consistent with those outlined by the US National High BP Education Program in 2002[95] for the primary prevention of hypertension:
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.
Pickering TG, Hall JE, Appel LJ, Falkner BE, Graves J, Hill MN, Jones DW, Kurtz T, Sheps SG, Roccella EJ (2005). Subcommittee of Professional Public Education of the American Heart Association Council on High Blood Pressure Research. "Recommendations for blood pressure measurement in humans and experimental animals: Part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research". Hypertension. 45 (5): 142–61. doi:10.1161/01.HYP.0000150859.47929.8e. PMID 15611362.
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:
Stress reduction techniques such as biofeedback or transcendental meditation may be considered as an add-on to other treatments to reduce hypertension, but do not have evidence for preventing cardiovascular disease on their own.[125][126][127] Self-monitoring and appointment reminders might support the use of other strategies to improve blood pressure control, but need further evaluation.[128]
Some heart attacks are sudden and intense, however most heart attacks start slowly with mild pain and discomfort. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain. Shortness of breath may occur, as well as nausea, or lightheadedness. It is vital to get help immediately if any of these symptoms occur.
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The molecular mechanism of metformin is incompletely understood. Multiple potential mechanisms of action have been proposed: inhibition of the mitochondrial respiratory chain (complex I), activation of AMP-activated protein kinase (AMPK), inhibition of glucagon-induced elevation of cyclic adenosine monophosphate (cAMP) with reduced activation of protein kinase A (PKA), inhibition of mitochondrial glycerophosphate dehydrogenase, and an effect on gut microbiota.[92][93][94] Ultimately, it decreases gluconeogenesis (liver glucose production).[76] It also has an insulin-sensitizing effect with multiple actions on tissues including the liver, skeletal muscle, endothelium, adipose tissue, and the ovary.[47][95] The average patient with type 2 diabetes has three times the normal rate of gluconeogenesis; metformin treatment reduces this by over one-third.[96]
You can have high blood pressure, or hypertension, and still feel just fine. That's because high blood pressure often does not cause signs of illness that you can see or feel. But, high blood pressure, sometimes called "the silent killer," is very common in older people and a major health problem. If high blood pressure isn't controlled with lifestyle changes and medicine, it can lead to stroke, heart disease, eye problems, kidney failure, and other health problems. High blood pressure can also cause shortness of breath during light physical activity or exercise.

^ Jump up to: a b c Bolen S, Feldman L, Vassy J, Wilson L, Yeh HC, Marinopoulos S, Wiley C, Selvin E, Wilson R, Bass EB, Brancati FL (September 2007). "Systematic review: comparative effectiveness and safety of oral medications for type 2 diabetes mellitus". Annals of Internal Medicine. 147 (6): 386–99. doi:10.7326/0003-4819-147-6-200709180-00178. PMID 17638715.
The first line of treatment for hypertension is lifestyle changes, including dietary changes, physical exercise, and weight loss. Though these have all been recommended in scientific advisories,[111] a Cochrane systematic review found no evidence for effects of weight loss diets on death, long-term complications or adverse events in persons with hypertension.[112] The review did find a decrease in blood pressure.[112] Their potential effectiveness is similar to and at times exceeds a single medication.[12] If hypertension is high enough to justify immediate use of medications, lifestyle changes are still recommended in conjunction with medication.
Metformin may rarely cause a serious, life-threatening condition called lactic acidosis. Tell your doctor if you have kidney disease. Your doctor will probably tell you not to take metformin. Also, tell your doctor if you are over 65 years old and if you have ever had a heart attack; stroke; diabetic ketoacidosis (blood sugar that is high enough to cause severe symptoms and requires emergency medical treatment); a coma; or heart or liver disease. Taking certain other medications with metformin may increase the risk of lactic acidosis. Tell your doctor if you are taking acetazolamide (Diamox), dichlorphenamide (Keveyis), methazolamide, topiramate (Topamax, in Qsymia), or zonisamide (Zonegran).
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.
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. 
African-Americans are at greater risk of developing hypertension than people of other races. African-Americans develop high blood pressure earlier in life and have more difficulty achieving blood pressure goals. Some studies suggest that African-Americans may be more sensitive to salt than other races. For those who are genetically prone to salt sensitivity, a small amount (half-teaspoon) of salt can raise blood pressure by 5 mm Hg. Dietary factors and being overweight can also raise blood pressure.
Metformin has been suggested as increasing production of lactate in the large intestine, which could potentially contribute to lactic acidosis in those with risk factors.[76] However, the clinical significance of this is unknown, and the risk of metformin-associated lactic acidosis is most commonly attributed to decreased hepatic uptake rather than increased intestinal production.[31][75][77]

If you drink alcohol often or in great quantity: Again, because metformin relies on the function of a healthy liver and kidneys, a person who drinks large amounts of alcohol on a regular basis would be putting themselves at an increased risk for other issues if they took metformin. If you are concerned about your personal alcohol consumption, take a look at these helpful resources listed at Alcohol.org.
Lactate uptake by the liver is diminished with metformin use because lactate is a substrate for hepatic gluconeogenesis, a process that metformin inhibits. In healthy individuals, this slight excess is cleared by other mechanisms (including uptake by unimpaired kidneys), and no significant elevation in blood levels of lactate occurs.[31] Given severely-impaired kidney function, clearance of metformin and lactate is reduced, increasing levels of both, and possibly causing lactic acid buildup. Because metformin decreases liver uptake of lactate, any condition that may precipitate lactic acidosis is a contraindication. Common causes include alcoholism (due to depletion of NAD+ stores), heart failure and respiratory disease (due to inadequate tissue oxygenation); the most common cause is kidney disease.[75]
However, the guidelines stress that, for most of the newly classified patients, the recommended treatment will be lifestyle modifications, such as weight loss and changes in diet and exercise levels, as opposed to medications. Only a small increase in the percentage of U.S. adults receiving blood pressure medications — about 2 percent — is expected, the authors said.
3. Implement strategies to lower inflammation. Several cross-sectional and longitudinal studies connect high blood pressure with chronic inflammation, a driving force for nearly every disease on the planet. Lowering inflammation starts with what you put on your fork. Focus on anti-inflammatory foods like wild-caught seafood (rich in omega-3 fatty acids), freshly ground flax and chia seeds, spices like turmeric, and plenty of colorful plant foods. Good sleep, stress management, exercise, and the right nutrients can also help lower inflammation.
Important complications of uncontrolled or poorly treated high blood pressure are due to chronic damage that occurs to different organs in the body and include heart attack, congestive heart failure, stroke, kidney failure, peripheral artery disease, and aneurysms (weakening of the walls of an artery, leading to a sac formation or ballooning of the artery wall). Aneurysms can be found in the brain, along the route of the aorta (the large artery that leaves the heart), and other arteries in the abdomen and extremities.
Creatinine is a chemical waste molecule that is generated from muscle metabolism. Creatinine is produced from creatine, a molecule of major importance for energy production in muscles. Creatinine has been found to be a fairly reliable indicator of kidney function. As the kidneys become impaired the creatinine level in the blood will rise. Normal levels of creatinine in the blood vary from gender and age of the individual.
Medicines are available if these changes do not help control your blood pressure within 3 to 6 months. Diuretics help rid your body of water and sodium. ACE inhibitors block the enzyme that raises your blood pressure. Other types of medicines— beta blockers, calcium channel blockers, and other vasodilators—work in different ways, but their overall effect is to help relax and widen your blood vessels and reduce the pressure inside the vessel. [See also the free government publication “Medicines to Help You: High Blood Pressure” (PDF) from the US Food and Drug Administration.]
The molecular mechanism of metformin is incompletely understood. Multiple potential mechanisms of action have been proposed: inhibition of the mitochondrial respiratory chain (complex I), activation of AMP-activated protein kinase (AMPK), inhibition of glucagon-induced elevation of cyclic adenosine monophosphate (cAMP) with reduced activation of protein kinase A (PKA), inhibition of mitochondrial glycerophosphate dehydrogenase, and an effect on gut microbiota.[92][93][94] Ultimately, it decreases gluconeogenesis (liver glucose production).[76] It also has an insulin-sensitizing effect with multiple actions on tissues including the liver, skeletal muscle, endothelium, adipose tissue, and the ovary.[47][95] The average patient with type 2 diabetes has three times the normal rate of gluconeogenesis; metformin treatment reduces this by over one-third.[96]
For older people, often the first number (systolic) is 130 or higher, but the second number (diastolic) is less than 80. This problem is called isolated systolic hypertension, which is due to age-related stiffening of the major arteries. It is the most common form of high blood pressure in older people and can lead to serious health problems (stroke, heart disease, eye problems, and kidney failure) in addition to shortness of breath during light physical activity, lightheadedness upon standing too fast, and falls. Isolated systolic hypertension is treated in the same way as regular high blood pressure (130 or higher for the first number, or 80 or higher for the second number) but may require more than one type of blood pressure medication. If your doctor determines that your systolic pressure is above a normal level for your age, ask how you can lower it.
Traditionally, blood pressure was measured non-invasively using ausculation with a mercury-tube sphygmomanometer.[1] Ausculation is still generally considered to be the gold standard of accuracy for non-invasive blood pressure readings in clinic.[2] However, semi-automated methods have become common, largely due to concerns about potential mercury toxicity,[3] although cost, ease of use and applicability to ambulatory blood pressure or home blood pressure measurements have also influenced this trend.[4] Early automated alternatives to mercury-tube sphygmomanometers were often seriously inaccurate, but modern devices validated to international standards achieve average difference between two standardized reading methods of 5 mm Hg or less and a standard deviation of less than 8 mm Hg.[4] Most of these semi-automated methods measure blood pressure using oscillometry.[5]
Some heart attacks are sudden and intense, however most heart attacks start slowly with mild pain and discomfort. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain. Shortness of breath may occur, as well as nausea, or lightheadedness. It is vital to get help immediately if any of these symptoms occur.
“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”.
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.

If your blood pressure remains high for a long period of time, you run the risk of damaging your blood vessels. Your stroke risk rises significantly, too. And because your heart is working harder to push blood through your system, that very valuable muscle can become overworked and grow thicker. An enlarged heart causes further complications, including heart failure. Medications and special implantable pumps can help boost heart function. But if you can manage your blood pressure before it gets too high and puts your heart at risk, you may be able to avoid a lot of complications down the road.
In 2017, the American College of Physicians's guidelines were updated to recognize metformin as the first-line treatment for type-2 diabetes. These guidelines supersede earlier reviews. For example, a 2014 review found tentative evidence that people treated with sulfonylureas had a higher risk of severe low blood sugar events (RR 5.64), though their risk of non-fatal cardiovascular events was lower than the risk of those treated with metformin (RR 0.67). There was not enough data available at that time to determine the relative risk of death or of death from heart disease.[27]
Malignant hypertension. This refers to extremely high blood pressures, over 180 mm Hg systolic or 120 mm Hg diastolic, that develop quickly and produces end organ damage. Malignant hypertension is a condition that requires immediate medical care. This condition is also known as hypertensive urgency or hypertensive emergency. Symptoms may occur as a result of organ damage, including confusion or mental status changes, blurred vision, seizures, shortness of breath, swelling, and chest pain due to angina, heart attack, or aneurysm.
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