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.
In people aged 18 years or older hypertension is defined as either a systolic or a diastolic blood pressure measurement consistently higher than an accepted normal value (this is above 129 or 139 mmHg systolic, 89 mmHg diastolic depending on the guideline). Other thresholds are used (135 mmHg systolic or 85 mmHg diastolic) if measurements are derived from 24-hour ambulatory or home monitoring. Recent international hypertension guidelines have also created categories below the hypertensive range to indicate a continuum of risk with higher blood pressures in the normal range. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC7) published in 2003 uses the term prehypertension for blood pressure in the range 120–139 mmHg systolic or 80–89 mmHg diastolic, while European Society of Hypertension Guidelines (2007) and British Hypertension Society (BHS) IV (2004) use optimal, normal and high normal categories to subdivide pressures below 140 mmHg systolic and 90 mmHg diastolic. Hypertension is also sub-classified: JNC7 distinguishes hypertension stage I, hypertension stage II, and isolated systolic hypertension. Isolated systolic hypertension refers to elevated systolic pressure with normal diastolic pressure and is common in the elderly. The ESH-ESC Guidelines (2007) and BHS IV (2004) additionally define a third stage (stage III hypertension) for people with systolic blood pressure exceeding 179 mmHg or a diastolic pressure over 109 mmHg. Hypertension is classified as "resistant" if medications do not reduce blood pressure to normal levels. In November 2017, the American Heart Association and American College of Cardiology published a joint guideline which updates the recommendations of the JNC7 report.
On average, diabetics are found to produce two to three times more glucose in their liver than non-diabetics. Metformin effectively suppresses glucose production in the liver. Metformin also makes cells more sensitive to insulin. Experts agree that diabetes starts with insulin resistance. Insulin is the courier that carries glucose from your food into cells. When cells resist, insulin is not able to deliver sugar into muscle and fat cells. Sugar then backs up in the bloodstream instead.
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.
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.
^ About Janusz Supniewski, see: Wołkow PP, Korbut R (April 2006). "Pharmacology at the Jagiellonian University in Kracow, short review of contribution to global science and cardiovascular research through 400 years of history" (pdf). Journal of Physiology and Pharmacology. 57 Suppl 1: 119–36. PMID 16766803. Archived (PDF) from the original on 2009-10-24.
‘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.
In type 2 diabetes the cells in the body, particularly muscle, fat and liver cells, become resistant to the action of insulin. Insulin is the main hormone responsible for controlling the level of sugar (glucose) in the blood. It makes cells in the body remove sugar from the blood. When the cells are resistant to insulin this makes blood sugar levels rise too high.
The relationship between metformin and weight is unclear, but several theories provide a plausible explanation for weight fluctuations. Reduced hunger is one proven side effect of metformin, according to the Mayo Clinic. It might not appear as if you’re eating less with this drug, but the number of calories you’re currently consuming for breakfast, lunch, and dinner might be lower than your normal food intake. This subtle change in appetite could be responsible for a gradual decline in weight.
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.
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.
The best evidence indicates that high blood pressure does not cause headaches or nosebleeds, except in the case of hypertensive crisis, a medical emergency when blood pressure is 180/120 mm Hg or higher. If your blood pressure is unusually high AND you have headache or nosebleed and are feeling unwell, wait five minutes and retest. If your reading remains at 180/120 mm Hg or higher, call 9-1-1.
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Blood pressure isn’t just a number. Chronically elevated blood pressure (hypertension) significantly increases your risk of heart disease, stroke, congestive heart failure, erectile dysfunction, eye disease (retinopathy), and kidney disease. Heart disease and stroke are two of the top five causes of death in the US (heart disease is #1), and hypertension is such a big contributor to both that the CDC claims hypertension was at least partially responsible for 410,000 deaths in the US in 2014.
Hypertension may not produce any symptoms, even if you have had it for years. That's why it is sometimes referred to as a "silent killer." It's estimated that 1 out of every 5 people with high blood pressure aren't aware that they have this major risk factor for strokes and heart attacks. If not properly treated, high blood pressure can damage the heart and circulation, lungs, brain, and kidneys without causing noticeable symptoms. Symptoms of high blood pressure may be present in those who have an extremely high blood pressure. Symptoms of extremely high blood pressure include the following:
^ Knowler WC, Fowler SE, Hamman RF, Christophi CA, Hoffman HJ, Brenneman AT, Brown-Friday JO, Goldberg R, Venditti E, Nathan DM, et al. (Diabetes Prevention Program Research Group) (November 2009). "10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study". Lancet. 374 (9702): 1677–86. doi:10.1016/S0140-6736(09)61457-4. PMC 3135022. PMID 19878986.
^ 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.
^ Aronow WS, Fleg JL, Pepine CJ, Artinian NT, Bakris G, Brown AS, Ferdinand KC, Ann Forciea M, Frishman WH, Jaigobin C, Kostis JB, Mancia G, Oparil S, Ortiz E, Reisin E, Rich MW, Schocken DD, Weber MA, Wesley DJ, Harrington RA, Bates ER, Bhatt DL, Bridges CR, Eisenberg MJ, Ferrari VA, Fisher JD, Gardner TJ, Gentile F, Gilson MF, Hlatky MA, Jacobs AK, Kaul S, Moliterno DJ, Mukherjee D, Rosenson RS, Stein JH, Weitz HH, Wesley DJ (2011). "ACCF/AHA 2011 expert consensus document on hypertension in the elderly: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents developed in collaboration with the American Academy of Neurology, American Geriatrics Society, American Society for Preventive Cardiology, American Society of Hypertension, American Society of Nephrology, Association of Black Cardiologists, and European Society of Hypertension". J Am Soc Hypertens. 5 (4): 259–352. doi:10.1016/j.jash.2011.06.001. PMID 21771565.
Related to weight loss is developing a healthy diet, another essential tool for lowering blood pressure. Healthy nutrition is important for all of the standard reasons (positive cardiovascular health, additional energy, etc.) and a few unique reasons as well. A low salt diet is particularly important for lowering blood pressure, as salt indirectly increases the volume of blood (by adding water to the bloodstream), which in turn increases blood pressure.
Half of American adults have this life-threatening condition, yet many are unaware or simply don’t take it seriously. But it doesn’t have to be that way. Hypertension is manageable and even preventable, but you have to know your risk factors and get your blood pressure checked (regularly!) to see if you’re at risk. Let’s take a closer look at what blood pressure actually is, how hypertension works, and how you can prevent the effects of high blood pressure to stave off heart disease.
^ Wulffelé MG, Kooy A, Lehert P, Bets D, Ogterop JC, Borger van der Burg B, Donker AJ, Stehouwer CD (November 2003). "Effects of short-term treatment with metformin on serum concentrations of homocysteine, folate and vitamin B12 in type 2 diabetes mellitus: a randomized, placebo-controlled trial". Journal of Internal Medicine. 254 (5): 455–63. doi:10.1046/j.1365-2796.2003.01213.x. PMID 14535967.
“I was diagnosed with PCOS at the age of 16 and at the age 18, I was told I would never conceive a child let alone carry to full term because of my PCOS. I have been on metformin since then I am now 29 yrs old and just had my 3rd child all because of metformin. I’m not going to lie this medication has its ups and downs but I’ve learned over the years to take it 1hr before my meals and always on time never skip a dose. I am now dropping weight like butter and I am currently on microgestin for birth control methods”.
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
^ Gurven, Michael; Blackwell, Aaron D.; Rodríguez, Daniel Eid; Stieglitz, Jonathan; Kaplan, Hillard (July 2012). "Does blood pressure inevitably rise with age?: longitudinal evidence among forager-horticulturalists". Hypertension (Dallas, Tex.: 1979). 60 (1): 25–33. doi:10.1161/HYPERTENSIONAHA.111.189100. ISSN 1524-4563. PMC 3392307. PMID 22700319.
Another way metformin is helpful to diabetic and pre-diabetic patients is that is has been shown to slow down and reduce the absorption of carbohydrates through intestines, which further helps control blood sugar levels. It also increases the ability of muscles to absorb glucose so that the body can use it more productively. Metformin is particularly useful at keeping night-time glucose levels in check, although it helps maintain the levels all throughout the day as well.
For how confusing hypertension can be, learning how to maintain a healthy blood pressure is surprisingly simple. As with other types of circulatory health, like cholesterol, the first step to lowering blood pressure is lifestyle change. “Whenever you’re dealing with hypertension, the first thing you need to deal with is lifestyle change,” Watnick explains. “Exercise is essential, weight control is essential. Eating a low-salt diet is quite important.” National guidelines recommend at least 30 minutes of exercise each day. For seniors, exercise can involve simple changes to everyday routine, like walking more often and engaging in household chores. In addition to improving overall cardiovascular health and cholesterol, the presence of which can increase blood pressure by narrowing arteries, exercise can also help with weight loss.
It is usually only when a person is in the midst of what is known as a hypertensive crisis — a period of extremely high blood pressure with a reading of 180/120 millimeters of mercury (mm Hg) or higher — that she or he will experience symptoms, such as a headache. This is considered a medical crisis, and if it occurs, you should call 911 and get emergency help.
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.
6. Cultivate stress management. You don’t need a meta-analysis of cohort studies to prove stress can raise blood pressure, but they exist. You can’t eliminate stress, but you can minimize its impact. Research shows yoga and meditation create effective strategies to manage stress and blood pressure. If those aren’t your thing, consider other stress-relieving tactics including deep breathing or practicing mindfulness.