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]
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

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.
Hypertension (HTN or HT), also known as high blood pressure (HBP), is a long-term medical condition in which the blood pressure in the arteries is persistently elevated.[10] High blood pressure typically does not cause symptoms.[1] Long-term high blood pressure, however, is a major risk factor for coronary artery disease, stroke, heart failure, atrial fibrillation, peripheral vascular disease, vision loss, chronic kidney disease, and dementia.[2][3][4][11]
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.

Instead of an arbitrary goal to “lose weight,” talk with your doctor about a healthy weight for you. The Centers for Disease Control and Prevention (CDC) recommends a weight loss goal of one to two pounds a week. That means starting off eating 500 calories less per day than what you normally eat. Then decide on what physical activity you can start in order to reach that goal. If exercising five nights a week is too hard to work into your schedule, aim for one more night than what you’re doing right now. When that fits comfortably into your schedule, add another night.
"Blood pressure guidelines are not updated at regular intervals. Instead, they are changed when sufficient new evidence suggests the old ones weren't accurate or relevant anymore," says Dr. Paul Conlin, an endocrinologist with Harvard-affiliated VA Boston Healthcare System and Brigham and Women's Hospital. "The goal now with the new guidelines is to help people address high blood pressure — and the problems that may accompany it like heart attack and stroke — much earlier."
Blood pressure is expressed by two measurements, the systolic and diastolic pressures, which are the maximum and minimum pressures, respectively.[1] For most adults, normal blood pressure at rest is within the range of 100–130 millimeters mercury (mmHg) systolic and 60–80 mmHg diastolic.[7][12] For most adults, high blood pressure is present if the resting blood pressure is persistently at or above 130/80 or 140/90 mmHg.[5][7] Different numbers apply to children.[13] Ambulatory blood pressure monitoring over a 24-hour period appears more accurate than office-based blood pressure measurement.[5][10]
Firstly, it increases the sensitivity of muscle cells to insulin. This enables these cells to remove sugar from the blood more effectively. Secondly, it reduces the amount of sugar produced by cells in the liver. Finally, it delays the absorption of sugar from the intestines into the bloodstream after eating so that there is less of a spike in blood sugar levels after meals.
^ Jump up to: a b Burt VL, Cutler JA, Higgins M, et al. (July 1995). "Trends in the prevalence, awareness, treatment, and control of hypertension in the adult US population. Data from the health examination surveys, 1960 to 1991". Hypertension. 26 (1): 60–69. doi:10.1161/01.HYP.26.1.60. PMID 7607734. Archived from the original on 2012-12-20. Retrieved 5 June 2009.
According to the procedure described in the 1975 Aron patent,[110] and the Pharmaceutical Manufacturing Encyclopedia,[111] equimolar amounts of dimethylamine and 2-cyanoguanidine are dissolved in toluene with cooling to make a concentrated solution, and an equimolar amount of hydrogen chloride is slowly added. The mixture begins to boil on its own, and after cooling, metformin hydrochloride precipitates with a 96% yield.
If your blood pressure is above the normal range for up to 5 readings (taken at different visits), your doctor will likely diagnose you with high blood pressure. Sometimes the doctor may diagnose you after a fewer number of readings, depending on how high above normal your blood pressure is and if you have other medical conditions. Blood pressure tends to be at its highest during exercise, physical work, or stress, and lowest during sleep. Everyone can have a temporary increase in blood pressure at one time or another, which is why it's important to take multiple readings.

‘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.


MRI (or magnetic resonance imaging) scan is a radiology technique which uses magnetism, radio waves, and a computer to produce images of body structures. MRI scanning is painless and does not involve X-ray radiation. Patients with heart pacemakers, metal implants, or metal chips or clips in or around the eyes cannot be scanned with MRI because of the effect of the magnet.
Fortunately, the senior years are not too late to take an active role in lowering blood pressure. Managing blood pressure can be as simple as increasing physical activity and regulating one’s diet. In those cases when a change in lifestyle doesn’t significantly impact hypertension, prescription drugs have proven very effective in regulating blood pressure.

Metformin is an excellent choice of medication for people with type 2 diabetes and is recommended as the preferred medication beginning at the time of diagnosis for those who don't have any contraindications (reasons not to use the drug.) Based on its mechanism of action it is not effective for people with type I diabetes. Metformin works to reduce insulin resistance in addition to other mechanisms of action. In contrast to many diabetes medications, it does not cause weight gain and does not have the side effect of hypoglycemia, which can be very serious.


Metformin is an oral medication which is classified as a biguanide. It is most often used for the management of type 2 diabetes when diet and exercise are not adequate in controlling high blood sugar levels. Metformin has an extensive safety record and medical research has proven that the medication is as good or better at controlling blood sugar levels when compared to other oral antidiabetic medication. When regularly taken, it decreases the amounts of glucose produced by the liver so that the body’s blood sugar levels are lowered. This medication also leads to a decrease in glucose absorption from the intestines and increases the body’s sensitivity to insulin so that it can be used more efficiently and effectively. However, as with all good news, there is a caveat. This medication comes with a lot of bothersome side effects which can be hard to manage. But there are many ways to lessen the side effects of Metformin or, in some cases, avoid them altogether so you can benefit from its stabilizing abilities without any unnecessary trouble.
So enjoy the great warm weather and take steps to get healthy. It’s never too late. For more information or to make an appointment with Dr. Barreto, please call MMH Medical Group at 315-769-4704. The MMH Medical Group is located in the new Medical Office Building at 181 Maple Street, Massena, across from the hospital. The MMH Medical Group offers same day sick call appointments and welcomes new patients and families to their practice.
High blood pressure is the most common chronic medical problem prompting visits to primary health care providers in USA. The American Heart Association estimated the direct and indirect costs of high blood pressure in 2010 as $76.6 billion.[144] In the US 80% of people with hypertension are aware of their condition, 71% take some antihypertensive medication, but only 48% of people aware that they have hypertension adequately control it.[144] Adequate management of hypertension can be hampered by inadequacies in the diagnosis, treatment, or control of high blood pressure.[164] Health care providers face many obstacles to achieving blood pressure control, including resistance to taking multiple medications to reach blood pressure goals. People also face the challenges of adhering to medicine schedules and making lifestyle changes. Nonetheless, the achievement of blood pressure goals is possible, and most importantly, lowering blood pressure significantly reduces the risk of death due to heart disease and stroke, the development of other debilitating conditions, and the cost associated with advanced medical care.[165][166]
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.
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.
Unchecked, high blood pressure can lead to a myriad of serious health problems, such as heart attacks, strokes, and other forms of heart disease and kidney disease. It is extremely dangerous during pregnancy because it contributes to devastating and even deadly problems for moms and babies. Other impacts of hypertension include vision problems and sexual dysfunction.
Secondary hypertension results from an identifiable cause. Kidney disease is the most common secondary cause of hypertension.[23] Hypertension can also be caused by endocrine conditions, such as Cushing's syndrome, hyperthyroidism, hypothyroidism, acromegaly, Conn's syndrome or hyperaldosteronism, renal artery stenosis (from atherosclerosis or fibromuscular dysplasia), hyperparathyroidism, and pheochromocytoma.[23][47] Other causes of secondary hypertension include obesity, sleep apnea, pregnancy, coarctation of the aorta, excessive eating of liquorice, excessive drinking of alcohol, and certain prescription medicines, herbal remedies, and illegal drugs such as cocaine and methamphetamine.[23][48] Arsenic exposure through drinking water has been shown to correlate with elevated blood pressure.[49][50]
Metformin was discovered in 1922.[13] French physician Jean Sterne began study in humans in the 1950s.[13] It was introduced as a medication in France in 1957 and the United States in 1995.[5][14] It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system.[15] Metformin is believed to be the most widely used medication for diabetes which is taken by mouth.[13] It is available as a generic medication.[5] The wholesale price in the developed world was between US$0.21 and US$5.55 per month as of 2014.[16] In the United States, it costs US$5 to US$25 per month.[5] In 2016 it was the 4th most prescribed medication in the United States with more than 81 million prescriptions.[17]
When you first start taking Metformin, you will likely lose some weight as the medication can cause feelings of fullness and a loss of appetite. If you start taking the medication while following a strict diet and exercise plan, then you may see a significant reduction in weight. This is a more desirous side effect as it is strongly suggested that diabetics lose weight so that their bodies have better control of their glucose levels and an improved insulin resistance.
Blood pressure is expressed by two measurements, the systolic and diastolic pressures, which are the maximum and minimum pressures, respectively.[1] For most adults, normal blood pressure at rest is within the range of 100–130 millimeters mercury (mmHg) systolic and 60–80 mmHg diastolic.[7][12] For most adults, high blood pressure is present if the resting blood pressure is persistently at or above 130/80 or 140/90 mmHg.[5][7] Different numbers apply to children.[13] Ambulatory blood pressure monitoring over a 24-hour period appears more accurate than office-based blood pressure measurement.[5][10]
Recent research shows that lowering your blood pressure below these levels decreases your risk of heart attacks and all-cause mortality. That’s right—lowering your blood pressure has a direct impact on your life expectancy. In fact, a person with a systolic pressure of 135 has double the risk of heart disease as someone with a systolic pressure of 115. Same goes for a diastolic pressure of 85 instead of 75. 10 points might not seem like much, but every blood pressure increase has a big impact on your health.
High blood pressure is usually caused by lifestyle factors as well as being genetically predisposed making up about 90-95% of cases hence being known as primary high pressure. Lifestyle factors can involve having excess sodium in the diet, high levels of body fat, smoking as well as alcohol. Secondary high blood pressure on the other hand is caused by an identifiable caused which is often time’s chronic kidney disease or even the use of birth control pills.
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.

People with stage 1 hypertension who don't meet these criteria should be treated with lifestyle modifications. These include: starting the "DASH" diet, which is high in fruit, vegetables and fiber and low in saturated fat and sodium (less than 1,500 mg per day); exercising for at least 30 minutes a day, three times a week; and restricting alcohol intake to less than two drinks a day for men and one drink a day for women, said vice chairman of the new guidelines, Dr. Robert Carey, a professor of medicine and dean emeritus at the University of Virginia Health System School of Medicine. [6 Healthy Habits Dramatically Reduce Heart Disease Risk in Women]
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Angiotensin receptor blockers prevent the actions of angiotensin II on the arteries. This means the arteries stay more open and blood pressure is lowered. ARBs can take a few weeks to work. Side effects can include dizziness, muscle cramps, insomnia, and elevated potassium levels. As with ACE inhibitors, women who are pregnant, planning to get pregnant, or breastfeeding should not take ARBs.
The guidelines also say that a patient's blood pressure levels should be based on an average of two to three readings on at least two different occasions. It's also reasonable for doctors to screen for "white-coat hypertension," which occurs when blood pressure is elevated in a medical setting but not in everyday life, the authors said. This can be done by having patients measure their blood pressure at home. 
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.
^ Jump up to: a b Calello DP, Liu KD, Wiegand TJ, Roberts DM, Lavergne V, Gosselin S, Hoffman RS, Nolin TD, Ghannoum M (August 2015). "Extracorporeal Treatment for Metformin Poisoning: Systematic Review and Recommendations From the Extracorporeal Treatments in Poisoning Workgroup". Critical Care Medicine. 43 (8): 1716–30. doi:10.1097/CCM.0000000000001002. PMID 25860205.
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. 
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