Blood Pressure

[keepbashing]

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

Thats not exactly how I would handle it.

Adding more medications also increases the risk of side effects. It is true that a second drug class can be introduced before, for example, increasing telmisartan to 80 mg (though in my opinion and experience, this is usually possible without issues). However, the side effect profile of telmisartan and lercanidipine is significantly better than if combined with a beta-blocker. That’s why the guideline recommends therapy with an ARB, calcium channel blockers, and thiazide-like diuretics (as I’ve explained, I’m hesitant to use these in athletes) up to the maximum daily dose before considering the use of nebivolol or eplerenone. Again, it would be either nebivolol or eplerenone, not a combination of both medications.

In terms of LVH, eplerenone is superior as it was developed as a medication for heart failure.

We were on the topic of lowering blood pressure, so I would leave LVH out of it. Cardio also doing a lot to lower your LVH risk.

If that still doesn’t work, there are alpha-blockers or renal artery ablation as options.

I may not be familiar with the studies you're referring to, but the EU guideline outlines the approach I’ve described.

 

[Sampei]

Thats not exactly how I would handle it.

Adding more medications also increases the risk of side effects. It is true that a second drug class can be introduced before, for example, increasing telmisartan to 80 mg (though in my opinion and experience, this is usually possible without issues). However, the side effect profile of telmisartan and lercanidipine is significantly better than if combined with a beta-blocker. That’s why the guideline recommends therapy with an ARB, calcium channel blockers, and thiazide-like diuretics (as I’ve explained, I’m hesitant to use these in athletes) up to the maximum daily dose before considering the use of nebivolol or eplerenone. Again, it would be either nebivolol or eplerenone, not a combination of both medications.

In terms of LVH, eplerenone is superior as it was developed as a medication for heart failure.

We were on the topic of lowering blood pressure, so I would leave LVH out of it. Cardio also doing a lot to lower your LVH risk.

If that still doesn’t work, there are alpha-blockers or renal artery ablation as options.

I may not be familiar with the studies you're referring to, but the EU guideline outlines the approach I’ve described.

So one could even combo eplenerone and a thiazide like diuretic together?

Nebivolol side effect profile tho is super mild, I would put it in a class of itself compared to any other beta blocker.

I do agree that telmisartan at 80mg is a great choice for many different reasons but why are you so against to use nebivolol at a maximum of 5mg compared to increasing the CCB to maximum dosage. I understood what you are saying about the CCB safety profile but what are the nebivolol effect you are more worried about?

 

[Mick]

I’m getting lost a little but I’m already on amlodipine. Don’t want to go nuts dropping and switching. Looks like I should add telimisartan next. And after that nebivolol if needed. I am a heavily muscled bodybuilder, 511 205 to 210. I don’t plan on letting go of the lifestyle. Already let go of a good bit of gear to get this in check. I will if I have to. But i am pretty hooked lol. Competed, started this shit at 17ish. Got on the gear at 23. I’m 36 now. Blasted and cruised the whole way. I took one 1 year 6 month break at 28 with 0 drugs. That’s the history on that. Not that it matters.

 

[Ghoul]

I’m getting lost a little but I’m already on amlodipine. Don’t want to go nuts dropping and switching. Looks like I should add telimisartan next. And after that nebivolol if needed. I am a heavily muscled bodybuilder, 511 205 to 210. I don’t plan on letting go of the lifestyle. Already let go of a good bit of gear to get this in check. I will if I have to. But i am pretty hooked lol. Competed, started this shit at 17ish. Got on the gear at 23. I’m 36 now. Blasted and cruised the whole way. I took one 1 year 6 month break at 28 with 0 drugs. That’s the history on that. Not that it matters.

Good plan. It's a truly proven combo that works without sides for the vast majority. It's unlikely you'll even need a 3rd tbh.

If the telm/amlo works, the only thing you may wish to consider when it's time to get more is switching to a single pill combo for convenience and savings.

Cilnipidine is a bit of an exotic option given its lack of availability in the US, but it's good to know it's there if water retention ever becomes an issue with amlodipine. (fewer than 10% of users). I've noticed less of the minor face bloat I thought was from Test or Minox, but now appears to have been from the amlodipine. My BP dropped another 2-3 points, and my RHR is down by 4.

 

[keepbashing]

So one could even combo eplenerone and a thiazide like diuretic together?

Nebivolol side effect profile tho is super mild, I would put it in a class of itself compared to any other beta blocker.

I do agree that telmisartan at 80mg is a great choice for many different reasons but why are you so against to use nebivolol at a maximum of 5mg compared to increasing the CCB to maximum dosage. I understood what you are saying about the CCB safety profile but what are the nebivolol effect you are more worried about?

I would only use the combination of two differently acting diuretics if there is no other way to achieve the therapeutic goal. Indapamide works at the early distal tubule by inhibiting the sodium-chloride cotransporter. This also affects other electrolytes, but that’s getting too detailed.

The point is, when I influence the kidney at a specific site (transporter), there are still other regulatory mechanisms in play. However, if I interfere with two fundamental secretion or reabsorption mechanisms of the kidney, I reduce its ability to respond to altered conditions.

In short, you could combine indapamide and eplerenone, but I wouldn't recommend it. The effect of eplerenone is also disproportionately stronger than that of indapamide at the maximum dose.

As for nebivolol, there is indeed a reason why it is currently the most commonly used substance from the class of selective beta-blockers in treatment-resistant hypertension. At a dose of 5 mg, nebivolol is relatively selective and certainly has a good efficacy-to-side-effect profile. I also don’t believe I’ve ever argued against nebivolol; I’ve simply listed nebivolol and eplerenone as options for therapeutic escalation.

The discussion then focused very specifically on eplerenone. That may have given the impression that I’m not considering nebivolol.

Ultimately, the choice of therapy is also patient-dependent, and without a complete medical history and further examinations, it is impossible to recommend the one and only best therapy. Therefore, the recommendations I make are primarily based on guidelines, studies, and my experience from working in the hospital.

 

[keepbashing]

I’m getting lost a little but I’m already on amlodipine. Don’t want to go nuts dropping and switching. Looks like I should add telimisartan next. And after that nebivolol if needed. I am a heavily muscled bodybuilder, 511 205 to 210. I don’t plan on letting go of the lifestyle. Already let go of a good bit of gear to get this in check. I will if I have to. But i am pretty hooked lol. Competed, started this shit at 17ish. Got on the gear at 23. I’m 36 now. Blasted and cruised the whole way. I took one 1 year 6 month break at 28 with 0 drugs. That’s the history on that. Not that it matters.

If you tolerate amlodipine well, there’s no reason not to continue taking it and, if needed, add telmisartan.

As I mentioned in my previous post, it is not possible to recommend the perfect therapy without examining you and knowing your lab values and other data.

However, the combination of amlodipine and telmisartan would be a common option for treating hypertension.

 

[Sampei]

I would only use the combination of two differently acting diuretics if there is no other way to achieve the therapeutic goal. Indapamide works at the early distal tubule by inhibiting the sodium-chloride cotransporter. This also affects other electrolytes, but that’s getting too detailed.

The point is, when I influence the kidney at a specific site (transporter), there are still other regulatory mechanisms in play. However, if I interfere with two fundamental secretion or reabsorption mechanisms of the kidney, I reduce its ability to respond to altered conditions.

In short, you could combine indapamide and eplerenone, but I wouldn't recommend it. The effect of eplerenone is also disproportionately stronger than that of indapamide at the maximum dose.

As for nebivolol, there is indeed a reason why it is currently the most commonly used substance from the class of selective beta-blockers in treatment-resistant hypertension. At a dose of 5 mg, nebivolol is relatively selective and certainly has a good efficacy-to-side-effect profile. I also don’t believe I’ve ever argued against nebivolol; I’ve simply listed nebivolol and eplerenone as options for therapeutic escalation.

The discussion then focused very specifically on eplerenone. That may have given the impression that I’m not considering nebivolol.

Ultimately, the choice of therapy is also patient-dependent, and without a complete medical history and further examinations, it is impossible to recommend the one and only best therapy. Therefore, the recommendations I make are primarily based on guidelines, studies, and my experience from working in the hospital.

Enjoyed the exchange, yeah I wouldn't use two diuretic either unless one is really fucked and can't control that BP even with all those other meds at already high dosages (but I believe it almost never happens)

What's the eplenerone suggested dosage? Who has a stronger diuretic effect and helps keeping a thin skin? Indapamide I believe is stronger Vs 50mg eplenerone (on the diuretic effect I mean).

 

[keepbashing]

Enjoyed the exchange, yeah I wouldn't use two diuretic either unless one is really fucked and can't control that BP even with all those other meds at already high dosages (but I believe it almost never happens)

What's the eplenerone suggested dosage? Who has a stronger diuretic effect and helps keeping a thin skin? Indapamide I believe is stronger Vs 50mg eplenerone (on the diuretic effect I mean).

Me too! The recommendation would be to start with 25 mg of eplerenone in the morning. This will be sufficient for most people.

if you wanna start minmaxing you could split your telmisartan dose, 40mg morning 40mg evening.

The diuretic effect of eplerenone is usually lower than that of indapamide. However, the effect of eplerenone is also highly dependent on the concentration of aldosterone. Therefore, the effect would be stronger in patients with high aldosterone levels compared to those with low aldosterone levels.

 

[Mick]

So what is with the potassium though when it come to telimisartan. Should I take it for a week and then get blood work and compare it with pre telimisartan blood work. I guess what I’m saying is should I get base blood work. Then start the telimisartan. Then get blood work again once I have been on it. The amlodipine might make me hold a little water but other then that no sides. Does amplodipine affect electrolyte balance as well??

 

[BamaCrazy]

So what is with the potassium though when it come to telimisartan. Should I take it for a week and then get blood work and compare it with pre telimisartan blood work. I guess what I’m saying is should I get base blood work. Then start the telimisartan. Then get blood work again once I have been on it. The amlodipine might make me hold a little water but other then that no sides. Does amplodipine affect electrolyte balance as well??

Start low on Telmisartan. I had no potassium issues at 20mg. But two weeks after increasing to 40mg my potassium levels were high and out of range. I dropped back down in about 30 days my levels were once again back in range. But I’m the rare person who has this issue. There are many members here on 80mg who never have potassium issues.

 

[Ghoul]

So what is with the potassium though when it come to telimisartan. Should I take it for a week and then get blood work and compare it with pre telimisartan blood work. I guess what I’m saying is should I get base blood work. Then start the telimisartan. Then get blood work again once I have been on it. The amlodipine might make me hold a little water but other then that no sides. Does amplodipine affect electrolyte balance as well??

Here's what the Cleveland Clinic recommends as far as tests and ongoing monitoring (yes start with a a baseline):

ACE inhibitors and ARBs: Managing potassium and renal function

Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) are used primarily to treat hypertension and are also useful for conditions such as heart failure and chronic kidney disease, independent of their effect on blood pressure. This article reviews the...

www.ccjm.org

My doctor did none of this when prescribing an ARB lol.

 

[AlexDavis43]

Start low on Telmisartan. I had no potassium issues at 20mg. But two weeks after increasing to 40mg my potassium levels were high and out of range. I dropped back down in about 30 days my levels were once again back in range. But I’m the rare person who has this issue. There are many members here on 80mg who never have potassium issues.

I had some dizzy issues when my doc bumped me from 8 to 16 mg candesartan (I think this is equivalent to 20 to 40 mg telmisartan).

Resolved after a few weeks, maybe because I started taking it in the evening instead of first thing in the morning.

 

[Mick]

Here's what the Cleveland Clinic recommends as far as tests and ongoing monitoring (yes start with a a baseline):

View attachment 323985View attachment 323986

ACE inhibitors and ARBs: Managing potassium and renal function

Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) are used primarily to treat hypertension and are also useful for conditions such as heart failure and chronic kidney disease, independent of their effect on blood pressure. This article reviews the...

www.ccjm.org

My doctor did none of this when prescribing an ARB lol.

Lmao your dr just went with it. That actually says a lot. Probably pretty rare ppl develop issues on a starting dose of otherwise healthy. I’m going to do blood work regardless. But that helps a lot. Thank you to everyone. I’m going to keep this update. Not be an idiot and blast, let my body recover. See if I can fix this. I again thank you, and everyone.

 

[BazzBeat]

Telmisartan helps kidneys to function properly, thereby removing water, and sodium as the main element. in a dosage of 80 mg, telmisartan causes frequent urination. I have a question. can telmisartan thereby cause dehydration, which can affect such indicators as hematocrit?

 

[Ghoul]

Telmisartan helps kidneys to function properly, thereby removing water, and sodium as the main element. in a dosage of 80 mg, telmisartan causes frequent urination. I have a question. can telmisartan thereby cause dehydration, which can affect such indicators as hematocrit?

Only if you had significant kidney disease before starting. Bad enough to cause edema (swelling, usually of the legs). Otherwise no. Improved kidney function regulates fluid balance better than damaged kidneys.

 

[BazzBeat]

Only if you had significant kidney disease before starting. Bad enough to cause edema (swelling, usually of the legs). Otherwise no. Improved kidney function regulates fluid balance better than damaged kidneys.

I have everything perfect and no swelling

 

[BazzBeat]

Only if you had significant kidney disease before starting. Bad enough to cause edema (swelling, usually of the legs). Otherwise no. Improved kidney function regulates fluid balance better than damaged kidneys.

maybe i drink too much water

 

[Ghoul]

maybe i drink too much water

You'd see it on a CBC blood test as low sodium.

 

[BazzBeat]

You'd see it on a CBC blood test as low sodium.

I have no swelling, no cramps. I can't understand. Maybe 80 mg is too high a dosage? And try to split 20 in the morning and 20 in the evening

 

[Sampei]

Check your potassium level