I'm using 5 mg nebivolol+ 20 mg olmesartan but my blood pressure is 140/90
Which of the two would be better to increase?
Which of the two would be better to increase?
MESO-Rx
Anabolic Steroids
Blood Pressure
- Thread starter gilmarpersonal
- Start date
Olmesartan but I would switch to telmisartan 40mg and see if it gets better keep the nebivolol of course
xrayphoton13
Member
Bump the ARB first. Try getting Amlodipine if you can. I was once struggling with bp hovering in the 130-140s even with 80mg telmisartan, 25mg hctz, 10mg nebivolol with mega doses of magnesium. I added 5mg amlodipine and was able to drop the hctz, cut the nebivolol to 2.5mg, and cut the telmisartan to 40mg. Got me to generally under 120/65 while blasting
RandallFlagg
Member
They make a combo Telmisartan-Amlodipine 40 mg/5 mg that would be optimal.
I was up to 80 mg Telmisartan and 5 mg Nebivolol but my systolic BP wouldn't budge under 135. Switched to Telmisartan 40 mg/Amlodipine 5 mg and bam ...120/70ish within a week. Of course individual results may vary...but adding the calcium channel blocker is a huge benefit in combination with the ARB.
Just watch out for hyperkalemia and increasing Creat (mild increases are pretty normal but definitely check blood work within 1 month if you start these).
If you're locked in to the current meds, agree with bumping the Olmesartan but I don't have direct experience with that particular ARB.
I was up to 80 mg Telmisartan and 5 mg Nebivolol but my systolic BP wouldn't budge under 135. Switched to Telmisartan 40 mg/Amlodipine 5 mg and bam ...120/70ish within a week. Of course individual results may vary...but adding the calcium channel blocker is a huge benefit in combination with the ARB.
Just watch out for hyperkalemia and increasing Creat (mild increases are pretty normal but definitely check blood work within 1 month if you start these).
If you're locked in to the current meds, agree with bumping the Olmesartan but I don't have direct experience with that particular ARB.
Which one can cause hyperkalemia, telmisartan, nebivolol or amlodipine?
Ghoul
Member
140/90 is serious, stage 2 hypertension.
The most up to date guidelines from the US and EU cardiology associations. would advise starting on a combination ARB/Calcium channel blocker.
For most people, the best choice for that would be Telmasartin/Amlodipine, 40/5.
Those two low dose meds combined will be more effective than a single high dose, with fewer side effects (likely none after a month).
Hyperkalemia can be caused by Telm, but it's very rare, and nearly unheard of at just 40mg.
Beta Blockers are a last choice, used for resistant hypertension and if you can avoid them, you'll be better off.
You can get both meds seperately (very cheap, even in the US with GoodRX), but a combo tab is even better.
I use these, $20, for 150.
That high of a BP is actively damaging you, I wouldn't wait to get it under control. Anything over 120/70 is now considered "elevated" and associated with health problems down the road. Unfortunately most primary care docs are far behind the current standards and don't keep up. I read and listen to many of the worlds leading cardiologists, and they call high BP the biggest threat to long term health, and are extremely frustrated with how poorly it's being addressed when solutions to get it under control are so cheap and easy.
One other note about Telmasartin. It rapidly degrades from humidity, and is supposed to be kept in blister packs or a bottle with a moisture absorber, not removed until just before use. A couple of days exposed to air reduces its effectiveness by 10% or more. Very few US pharmacists seem to be aware of this, and dispense it loose in the amber plastic bottles, when they should be in manufacturer's packaging.
Last edited:
BamaCrazy
Member
Most ARBs can. Losartan, Telmisartan, etc. 20mg Telmisartan has mine out of range right now.
Well Ghoul everything is correct except the statement beta blocker are better avoided. I would agree with that except for nebivolol.
It's a fantastic substitute of amlodipine (if BP stays in range) and has great benefits all around if kept at 5mg and no noticeable side effect.
Ghoul
Member
Of course everyone's entitled to their opinion, drawn from their experience etc.
However, every set of hypertension treatment guidelines from medical organizations. which are updated based on evidence every few years, have increasingly discouraged use of beta blockers and reserve them as a last resort for treatment resistant hypertension, because of the negative consequences associated with their use(more strokes, being the primary reason).
TLDR the steps are currently in the order of:
ACE/ARB + Calcium channel blocker minimum doses.
Increase doses of one or both to maximum tolerable if bp not at target.
If still not at target, add diuretic.
Finally, if still not working add a Beta Blocker.
I have never read of more strokes associated with nebivolol. I agree ok the whole beta blocker but not for something as selective as nebivolol.
Do you have any literature on nebivolol and the side effect you are talking about?
They even made a new medication where nebivo is used with amlodipine in a combo med
Effect of Amlodipine/Nebivolol combination therapy on central BP and PWV compared to Amlodipine/Valsartan combination therapy - The Egyptian Heart Journal
Background Pulse wave velocity (PWV) and central blood pressure (CBP) have been intoduced into managment of hypertensive patients. PWV is positively correlated with arterial wall stiffness while central aortic pressure becomes better predictor of cardiovascular outcome than peripheral pressure...
tehj.springeropen.com
Amlodipine is more efficacious in lowering BP that's why it's recommended but we are bodybuilders and nebivololo has a less side effect then amlodipine and a better profile imho for who's lifting.
Last edited:
Ghoul
Member
I started keeping a file of the studies I read, since backtracking to find some reference I came across earlier became too time consuming.
AlexDavis43
Member
To reduce blood pressure in someone with low insulin? Or just to increase insulin? Seems weird either way, or at least out of context.
No wonder this didn't receive any responses. Please be more specific.
BamaCrazy
Member
I think he’s asking Ghoul for research on low insulin. His lab results had his insulin at 2.3 when the low end should be higher than 2.6 acvordijg to LabCorp. But his glucose was normal plus some labs state the range for insulin is 2.0-25. He’s fine and worried about nothing.
29trt
Member
Make sure that the lab that got your blood did the test locally otherwise your insulin reading will be low .
I don't know why this is not talked about more often as it's a big deal when you are calculating homa IR and the blood glucose is ussually done locally and is correct and the insulin is sent to a different lab as it is a more speciliazed test and comes back much lower and screws up the ratio...
stargab
New Member
I have so far only used Telmisartan which brings my BP to around 120-130 on blast. Would you recommend adding Nebivolol if I get a very clear pulse during blast?
MA11
Member
@Ghoul
You say everything above 120/70 is considered elevated yet the flowchart classifies the patient as hypertensive when above 150/90.
When do US cardiologists prescribe BP meds to otherwise healthy individuals?
Both my cardiologist and my GP didn't want to put me on meds when I averaged 135/75 during the day. That's was in the past.
Meanwhile I was prescribed 80 mg Telmisartan ED.
I'll ask my doc next time why he preferred high dose sartan over mid dose and a CCB.
Located in Europe btw.
You say everything above 120/70 is considered elevated yet the flowchart classifies the patient as hypertensive when above 150/90.
When do US cardiologists prescribe BP meds to otherwise healthy individuals?
Both my cardiologist and my GP didn't want to put me on meds when I averaged 135/75 during the day. That's was in the past.
Meanwhile I was prescribed 80 mg Telmisartan ED.
I'll ask my doc next time why he preferred high dose sartan over mid dose and a CCB.
Located in Europe btw.
Ghoul
Member
Reasonable question. Unfortunately the flowcharts I can find are based on older standards.
Worse yet, most primary care providers, in my experience, are treating based on knowledge decades out of date.
Here's a summary of the most current EU guideline changes:
2024 ESC Clinical Practice Guidelines for the Management of Elevated Blood Pressure and Hypertension
Your access to the latest cardiovascular news, science, tools and resources.
www.escardio.org
The guidelines themselves;
Here's the reference to low dose, dual class (ARB/CCB) , single pill, medication as "first line treatment" is recommended;
US also introduced the same new guidelines in 2024.
Last edited:
