I'd say you need a new doctor. HCTZ is not a suitable first line antihypertensive for anyone, bodybuilders in particular. Here are my thoughts on antihypertensives for this community, thank you to
@Ghoul who turned me on to cilnidipine as I was completely unaware of it being off the USA formulary (not worth US Pharma paying off FDA to get it approved since they won't be able to make a fortune with exclusive sales, sad but true).
My first line is ARB; while ACE inhibitors have the same ultimate end effect, they work indirectly and can produce the infamous cough - their ACE target enzyme is found in the lungs, while the ultimate AT1 target is in the kidneys. ARBs are the -sartan drugs (including losartan, candesartan, telmisartan, azilsartan, etc). Telmisartan is very popular and effective, besides being an ARB it also has partial PPARγ agonism. Azilsartan is a smaller molecule with prolonged active time on AT1, and also a partial PPARγ agonist although somewhat less so than telmisartan. Dosage is typically 40-80mg for telmisartan/azilsartan, I suggest taking them at night before bed. ARBs are known to mitigate LVH, those with normal blood pressure might want to consider using a small 20mg dose for that purpose alone. Over 80mg there is little added benefit, basically that's near where the drugs saturate the AT1 receptors. In some people, ARB and ACE inhibitor drugs can cause hyperkalemia, so check blood chemistries after initiating therapy to make sure K+ is not too high; mine was borderline at 5.3 with 80mg/day azilsartan, although I was taking a decent amount of extended release potassium citrate (for kidney stone prophylaxis, I've had a few)... I replaced most of that with frequent doses of magnesium citrate now which has helped.
Next is CCB; amlodipine (L channel blocker) is most commonly prescribed in the USA but cilnitidine (L+N channel blocker) is a far superior drug - particularly for bodybuilders - and worth buying from overseas. Dosage is typically 5-20mg, I suggest taking upon waking up. Basically cilnidipine both relaxes the blood vessels directly via the L channels, and reduces sympathetic nervous system outflow via the N channels. The latter is key for me, as I have an over-responsive sympathetic nervous system and a dampened parasympathetic nervous system from using retatrutide.
HCTZ is a potassium-sparing diuretic and best for older, ill people with edema from heart failure, kidney failure, liver failure/cirrhosis, etc. I don't think it should ever be used as a first line antihypertensive for bodybuilders. Excessive fluid retention with PEDs is typically from excessive estrogen, that is resolved by reducing total aromatizing compounds and/or aromatization via judicious use of an AI (typically exemestate or anastrozole). GH can cause water retention too, if so reduce the dose and/or try another brand. Excessive sodium and carbohydrate intake can cause fluid retention too. So don't be a water buffalo in the first place.
HCTZ also has more significant potential side effects including electrolyte imbalances, ED, insulin resistance, and worsening of lipid profile (elevated TC/LDL//trigs and reduced HDL, pretty much the last things men using PEDs need). That all said, using HCTZ to use as a diuretic for a photo shoot or transiently while excess water retention is being addressed from the source. I have yet to use it, but my wife likes to take one the day before a photo shoot.
BB: Not really much place for them for blood pressure control. Formerly I used Nebivolol in hopes of reducing RHR and day time blood pressure, first 5mg/day then 10mg/day in the am. It really didn't do much at either dose. And adding a BB exacerbates any hyperkalemia that some people get from using ARBs. For anxiety, small doses of propranolol, the OG beta blocker which crosses the blood-brain barrier, can be calming. The newer, cardioselective beta blockers are really best utilized by patients with specific heart issues that require them.
My RHR is not exceedingly high but higher than I prefer (often low 80s resting, which would sometimes bother me at night when trying to sleep) from use of androgens, 7.5iu/day GH + Retatrudide 4mg/wk, and potentially some reflex tachycardia from the other blood pressure meds. What works beautifully for this is ivabradine, it acts selectively on the sinoatrial node to inhibit the funny current. Starting dosage is 2.5mg twice a day, which can be increased up to 7.5mg twice a day. I found each 5mg/day drops RHR about 10 points; at least in me, it has zero other effects. It can also improve ejection fraction by giving the ventricle more time to fill during diastole; that's really its main on-label indication.
I can make a similar post about lipid management too, if anyone wants. Anyone on more than HRT dose test really needs to be aggressive with that, if they want to avoid cardiovascular disease over the long haul. All androgens inherently raise LDL and reduce HDL - testosterone included - and anyone who lives supraphysiologic really should be keeping their LDL < 55, and that won't happen with supplements alone.
