Blood Pressure

[Slowww]

I move all day working. Very very active. 430 am wake up. And in bed at 830 pm. Basically move the entire time in some way. This includes gym 3 days a week. Backed off from.5 do to recovery issues. Walling the dogs, probably get 10-15k steps in maybe more. I do not have a c pap. Going to get on that. I take 2iu hgh before bed. The only thing I'm not doing is daily fasted cardio like I should. And no medications other then the amlodipine. I was on more but had some anxiety issues so got off everything and started adding things back in one at a time. How much can stress contribute? This all seemed to start a year a ago I was running a construction site and shit went to hell. Lol. Anxiety kicked up there too

I don’t think you even need to get the cardio in fasted for BP, it just has to be the within the appropriate heart rate to see improvements. If it’s just for lowering BP, not for weight loss, just get it done, food in or not. Do it consistently like 5-7 days a week, starting at like 20-30 minutes, maybe even split AM PM, any time you get a chance.

I also have a very active job, that gets me anywhere from 9-15k steps per day, but there is a difference when I add cardio as well in terms of blood pressure 5-6 days a week. Especially getting from bulk to cut, time will make a difference it can go from like 126 at the start (25 min 5/7 days) with short cardio to 104-110 when cardio gets to 40-60 minutes 6/7 days.

 

[Nidus]

I don’t think you even need to get the cardio in fasted for BP, it just has to be the within the appropriate heart rate to see improvements. If it’s just for lowering BP, not for weight loss, just get it done, food in or not. Do it consistently like 5-7 days a week, starting at like 20-30 minutes, maybe even split AM PM, any time you get a chance.

I also have a very active job, that gets me anywhere from 9-15k steps per day, but there is a difference when I add cardio as well in terms of blood pressure 5-6 days a week. Especially getting from bulk to cut, time will make a difference it can go from like 126 at the start (25 min 5/7 days) with short cardio to 104-110 when cardio gets to 40-60 minutes 6/7 days.

This. 30 minutes of cardio at 125-130bpm improved my resting heartrate within 2 weeks by 12 already.
Doing 30 mins daily, either morning or in the afternoon.

 

[Slowww]

This. 30 minutes of cardio at 125-130bpm improved my resting heartrate within 2 weeks by 12 already.
Doing 30 mins daily, either morning or in the afternoon.

Absolutely, cardio, improving cardiac conditioning with exercise should probably be the initial treatment method imo because the effects are significant. This is another one of those things where it seems like everyone just wants to rely on pills to “fix”

 

[Mick]

Fasted cardio is not better for blood pressure or fat loss than any other cardio.

If you don't get fasted cardio in the morning then not all is lost. You can still do it later in the day and get the same benefits.

Gotcha. I didn’t know it isn’t. Better. But I did know even if it was better it was marginal at best. It is just the cardio that makes me feel the best. I do “cardio by walking the dogs a mile plus daily also but don’t even count that. As the morning cardio on the treadmill gives me that sweat and I can control the incline and speed. Just really like it. I’m also going to implement some 10 walks and donate some blood. As I just came off a cycle using primo which sometimes makes my hemoglobin go up. I have to do a lot of shit lol. It’s is now my full focus because it’s not going as easy as I thought it would lol.

 

[Mick]

I have an appt with a cardiologist in two weeks also. So we will see what they say also.

 

[Ghoul]

Absolutely, cardio, improving cardiac conditioning with exercise should probably be the initial treatment method imo because the effects are significant. This is another one of those things where it seems like everyone just wants to rely on pills to “fix”

No. The much, much bigger problem is that people live with elevated BP for years that isn't brought into normal range through other means because they're trying to avoid taking medication.

Only 20% who need meds to bring BP down, and that's the majority of adults over 40, comply with treatment. The excess rate of heart attacks, strokes, kidney failure, and neurodegeneration caused by the resistance to the so-called "easy fix" is at epidemic levels.

 

[Slowww]

No. The much, much bigger problem is that people live with elevated BP for years that isn't brought into normal range through other means because they're trying to avoid taking medication.

Only 20% who need meds to bring BP down, and that's the majority of adults over 40, comply with treatment. The excess rate of heart attacks, strokes, kidney failure, and neurodegeneration caused by the resistance to the so-called "easy fix" is at epidemic levels.

I’m not talking about in general, I mean based on what I see on PED forums.

 

[Mick]

I’m willing to do it all. Lmao. Just want to start with one thing at a time. So amplodipine 5mg. One baby aspirin. Leviathan full line (hemo flow, IRE, heart supp,) true beets. After 2 weeks of cardio if no improvement I will add telimisartan at 30 mg. Then I will decide if I either up the two medications I’m on or add another. I just need to get my ass on it with the bloods and do blood work pre telimisartan and post to make sure my potassium is good. I feel confident I can do this. Esp with your guys support and knowledge. I’m going to spend some more time reading this weekend too. See what I can learn and add to my protocol. I’m pretty sure ghoul told me before combo of telimisartan and amlodipine is a good one!

 

[Ghoul]

I’m willing to do it all. Lmao. Just want to start with one thing at a time. So amplodipine 5mg. One baby aspirin. Leviathan full line (hemo flow, IRE, heart supp,) true beets. After 2 weeks of cardio if no improvement I will add telimisartan at 30 mg. Then I will decide if I either up the two medications I’m on or add another. I just need to get my ass on it with the bloods and do blood work pre telimisartan and post to make sure my potassium is good. I feel confident I can do this. Esp with your guys support and knowledge. I’m going to spend some more time reading this weekend too. See what I can learn and add to my protocol. I’m pretty sure ghoul told me before combo of telimisartan and amlodipine is a good one!

The three major high blood pressure treatment guideline setting organizations in the world, European Society of Cardiologists, American
College of Cardiology, and International Society of Hypertension all now recommend low dose dual class BP should be the first line of treatment for hypertension stage 1 (instead of single med).

Based on those standards, a major medical conference in India at the end of 2023 came to the conclusion that the default combination in India should be low dose Telmasartin/Amlodipine because of its proven efficacy and excellent safety record. (low cost was also a factor, and they mention that Cilnipidine may be used for the small minority who get edema from Amlodipine)

So if Amlodipine and lifestyle changes don't get you to the target range <130/80, don't increase the dose, add the Telmisartan (or better yet get a single pill combo).

https://journal-api.s3.ap-south-1.amazonaws.com/issues/articles/japi-71-12-56.pdf

 

[Mick]

Got it. We will see what happenes. Did 45 min cardio today. May implement 10 walks also after each meal. Making sure I get 8 hours sleep at min. No caffeine. I just need to stay disciplined. No different than doing an NPC show lmao. Like I said I am in 5mg amlodipine. And have 30 mg telimisartan. What is maximum medical dose of those two medications?

 

[Ghoul]

Got it. We will see what happenes. Did 45 min cardio today. May implement 10 walks also after each meal. Making sure I get 8 hours sleep at min. No caffeine. I just need to stay disciplined. No different than doing an NPC show lmao. Like I said I am in 5mg amlodipine. And have 30 mg telimisartan. What is maximum medical dose of those two medications?

10 of amlodipine and 80 for telm.

However, the added BP reduction is minimal when doubling the dose, while the risk of sides goes up considerably. That's why the current thinking is minimum dose for any BP med and add a minimum dose from another class. IE: Start with ARB+CCB, then if needed add a 3rd, beta blocker or diuretic, then (rarely) a 4th.

One side note, if Telm 40/Amlodipine 5 doesn't bring you into optimal BP range(<120/80), but DIASTOLIC is high while systolic is below or near 120, raising Telm to 80 will reduce diastolic more than systolic, Raising Amlodipine to 10 will lower both, which may be too much reduction for systolic causing lightheadedness.

 

[keepbashing]

Ghoul has already mentioned most of the relevant facts on this topic. It is worth adding that, based on my clinical experience ad the outcome of some clinic studies as well as guidelines, ARBs are to be recommended as first-line medication, even before calcium channel blockers. If dual therapy becomes necessary, I would prefer Lercanidipine over Amlodipine. The starting dose would be 10 mg in the morning. Without going too much into detail, the side effect profile is better, and due to its high lipophilicity, the receptor half-life is longer.

It is important to note that Lercanidipine must be taken on an empty stomach, at least 30—preferably 60 to 90—minutes before breakfast.

My personal recommendation—if 80 mg of Telmisartan and 20 mg of Lercanidipine do not sufficiently lower blood pressure—would be to add either 5 mg of Nebivolol or 25 mg of Eplerenone. In my opinion, thiazide-like diuretics have too many disadvantages for this type of patient. Of course, this always varies from person to person.

 

[Mongo966]

Got it. We will see what happenes. Did 45 min cardio today. May implement 10 walks also after each meal. Making sure I get 8 hours sleep at min. No caffeine. I just need to stay disciplined. No different than doing an NPC show lmao. Like I said I am in 5mg amlodipine. And have 30 mg telimisartan. What is maximum medical dose of those two medications?

My blood pressure likes to stay on the high-normal side. It took me a little while to figure out the best volume and intensity I needed for the best returns.

My BP is usually 135/80 and comes down to 120/75 for around 24 hours if I do an hour of cardio with my heart rate in the middle of zone 2. If i increase the intensity(>zone 2), it has a similar effect on blood pressure but my resting heart rate stays a bit elevated for that same 24 hour period. Short high intensity stuff works well but it keeps my rhr elevated quite a bit for at least a few hours afterwards, and at 41 years old the recovery time in general makes it tough to make a daily routine out of it.
Those are observations i've made for myself. My blood pressure is a pain in the ass to work with. You may not have the same issues.
That's all just to say: if you aren't getting the returns you're looking for it may be because you're working too hard and/or not long enough etc. There's a ton of literature out there on this stuff too in case you find you need to build a certain strategy for maximum efficiency.
Best of luck!

 

[Sampei]

Ghoul has already mentioned most of the relevant facts on this topic. It is worth adding that, based on my clinical experience ad the outcome of some clinic studies as well as guidelines, ARBs are to be recommended as first-line medication, even before calcium channel blockers. If dual therapy becomes necessary, I would prefer Lercanidipine over Amlodipine. The starting dose would be 10 mg in the morning. Without going too much into detail, the side effect profile is better, and due to its high lipophilicity, the receptor half-life is longer.

It is important to note that Lercanidipine must be taken on an empty stomach, at least 30—preferably 60 to 90—minutes before breakfast.

My personal recommendation—if 80 mg of Telmisartan and 20 mg of Lercanidipine do not sufficiently lower blood pressure—would be to add either 5 mg of Nebivolol or 25 mg of Eplerenone. In my opinion, thiazide-like diuretics have too many disadvantages for this type of patient. Of course, this always varies from person to person.

Lercanidipine can be taken before bed as well, no need to be taken before breakfast like it's mandatory

Eplenerone is a shit fucking suggestion for a bodybuilder plus very nice idea to use a sparring potassium diuretic with telmisartan, so you can go in hyperkalemia for sure.

 

[keepbashing]

Lercanidipine can be taken before bed as well, no need to be taken before breakfast like it's mandatory

Eplenerone is a shit fucking suggestion for a bodybuilder plus very nice idea to use a sparring potassium diuretic with telmisartan, so you can go in hyperkalemia for sure.

I don’t have the time or desire for a lengthy discussion. Lercanidipine is recommended in the morning partly because absorption on an empty stomach is absolutely necessary and partly because the vasodilation it causes can lead to sympathetic activation, which in turn can result in sleep disturbances.

The half-life of both medications is long enough to provide coverage even for non-dippers.

So take it whenever you prefer, but the recommendation for morning administration is based on solid reasoning.

Edit:
Okay, if that’s how you want it. Eplerenone is absolutely standard in cases of treatment-resistant hypertension and, in a generally healthy patient without kidney disease, it will not cause hyperkalemia when combined with 80 mg of telmisartan. Budget doctors with their Google degrees like you are seriously testing my patience at the clinic. Not because of the questions you ask, but because of your insane arrogance and the assumption that you know what you’re talking about after ten minutes of Googling.

The EU guidelines for hypertension recommend eplerenone (technically spironolactone, but that would be a poor choice) as part of triple therapy resistant hypertension when potassium is below 4.5 mmol/L. Alternatively, nebivolol is an option. After consulting with a nephrology colleague some time ago, he told me he would prescribe ARBs and eplerenone without hesitation in kidney-healthy patients with potassium levels up to 5 mmol/L. Of course, monitoring over a few months is advisable.
Not to forget the positive effects eplerenone has on the vascular system and the heart.

What you've ultimately demonstrated is your ability to use Google, but not your ability to use your brain—let alone any actual medical training.

 

[Sampei]

I don’t have the time or desire for a lengthy discussion. Lercanidipine is recommended in the morning partly because absorption on an empty stomach is absolutely necessary and partly because the vasodilation it causes can lead to sympathetic activation, which in turn can result in sleep disturbances.

The half-life of both medications is long enough to provide coverage even for non-dippers.

So take it whenever you prefer, but the recommendation for morning administration is based on solid reasoning.

Edit:
Okay, if that’s how you want it. Eplerenone is absolutely standard in cases of treatment-resistant hypertension and, in a generally healthy patient without kidney disease, it will not cause hyperkalemia when combined with 80 mg of telmisartan. Budget doctors with their Google degrees like you are seriously testing my patience at the clinic. Not because of the questions you ask, but because of your insane arrogance and the assumption that you know what you’re talking about after ten minutes of Googling.

The EU guidelines for hypertension recommend eplerenone (technically spironolactone, but that would be a poor choice) as part of triple therapy resistant hypertension when potassium is below 4.5 mmol/L. Alternatively, nebivolol is an option. After consulting with a nephrology colleague some time ago, he told me he would prescribe ARBs and eplerenone without hesitation in kidney-healthy patients with potassium levels up to 5 mmol/L. Of course, monitoring over a few months is advisable.
Not to forget the positive effects eplerenone has on the vascular system and the heart.

What you've ultimately demonstrated is your ability to use Google, but not your ability to use your brain—let alone any actual medical training.

So for a bodybuilder that already put stress on the kidney with an high protein diet and can take nebivolol instead that has a lot more benefit and a lot less side effect of eplerenone... Let's take a diuretic that has the main side effect: hyperkalemia.

I'm not saying it's not effective but before going that route I believe there are better option don't you think?

 

[keepbashing]

So for a bodybuilder that already put stress on the kidney with an high protein diet and can take nebivolol instead that has a lot more benefit and a lot less side effect of eplerenone... Let's take a diuretic that has the main side effect: hyperkalemia.

I'm not saying it's not effective but before going that route I believe there are better option don't you think?

the strain on a bodybuilder’s kidneys in nearly all cases is too low to impair the kidneys’ ability to regulate electrolytes in the blood.

Eplerenone can be used down to an eGFR of >30 ml/min. A bodybuilder with a cystatin-C-based eGFR below 30 ml/min has bigger problems and should probably consider a different sport.

As I already mentioned, eplerenone should be used when ARBs and CCBs at maximum doses do not yield the desired results. I still stand by the statement that a strength athlete benefits more from eplerenone as the third medication in this combination than from a thiazide-like diuretic.

The risk of hyperkalemia on this medication is low in otherwise healthy patients with normal eGFR, and hyperkalemia is rare and absolutely manageable—even when combined with ARBs.

The regulation via aldosterone at the cytosolic mineralocorticoid receptor of kidney cells and its influence on ROMK is not the only mechanism for controlling the serum potassium concentration.

 

[Sampei]

the strain on a bodybuilder’s kidneys in nearly all cases is too low to impair the kidneys’ ability to regulate electrolytes in the blood.

Eplerenone can be used down to an eGFR of >30 ml/min. A bodybuilder with a cystatin-C-based eGFR below 30 ml/min has bigger problems and should probably consider a different sport.

As I already mentioned, eplerenone should be used when ARBs and CCBs at maximum doses do not yield the desired results. I still stand by the statement that a strength athlete benefits more from eplerenone as the third medication in this combination than from a thiazide-like diuretic.

The risk of hyperkalemia on this medication is low in otherwise healthy patients with normal eGFR, and hyperkalemia is rare and absolutely manageable—even when combined with ARBs.

The regulation via aldosterone at the cytosolic mineralocorticoid receptor of kidney cells and its influence on ROMK is not the only mechanism for controlling the serum potassium concentration.

Wouldn't indapamide be better as it can bring hypokalemia and balance the possible hyperkalemia of Telmisartan for example?

 

[keepbashing]

Indapamide has a greater impact on electrolytes in the serum than eplerenone, while simultaneously having a significantly weaker blood pressure-lowering effect. Athletes, in particular, can experience performance decline and cramps due to drugs like indapamide (a thiazide-like diuretic).

Compared to eplerenone, indapamide is truly just a drop in the ocean, and in practice, its blood pressure-lowering effect is nowhere near sufficient when even 80 mg of telmisartan and 20 mg of lercanidipine are unable to bring the pressure down below 120-130 mmHg.

Also, you need to stop assuming hyperkalemia all the time. We're talking about young to middle-aged athletes who generally maintain a healthy lifestyle (with exceptions) and are mindful of their health. This type of patient almost never experiences issues with hyperkalemia from ARBs, nor from the combination of ARB and eplerenone.

Just because it is listed as a general side effect doesn't mean it affects every person or every patient group in the same way.

*And of course, nebivolol is also an alternative, but it also has side effects. Therefore, it always comes down to a matter of weighing the options.

 

[Sampei]

Indapamide has a greater impact on electrolytes in the serum than eplerenone, while simultaneously having a significantly weaker blood pressure-lowering effect. Athletes, in particular, can experience performance decline and cramps due to drugs like indapamide (a thiazide-like diuretic).

Compared to eplerenone, indapamide is truly just a drop in the ocean, and in practice, its blood pressure-lowering effect is nowhere near sufficient when even 80 mg of telmisartan and 20 mg of lercanidipine are unable to bring the pressure down below 120-130 mmHg.

Also, you need to stop assuming hyperkalemia all the time. We're talking about young to middle-aged athletes who generally maintain a healthy lifestyle (with exceptions) and are mindful of their health. This type of patient almost never experiences issues with hyperkalemia from ARBs, nor from the combination of ARB and eplerenone.

Just because it is listed as a general side effect doesn't mean it affects every person or every patient group in the same way.

*And of course, nebivolol is also an alternative, but it also has side effects. Therefore, it always comes down to a matter of weighing the options.

It's a lot better to combine 4 medications compared to raise lercanidipine to 20mg at least from the latest studies of using quad low dosage bp.medication Vs rasing to maximum dosage 2 meds for example.

So probably better to keep lerca at 10mg and add 5mg nebi and eplenerone at low dosage.

Btw indapamide has been shown to reduce LVH something quite important for a bodybuilder