I'm switching to telmisartan from lisinopril (need advice)

[Theworm]

so whats your stance on cholesterol? I saw some stuff about how we are wrong about blood cholesterol, atleast as far as LDL goes, and i think the indicator is VLDL? I lowered my LDL from 130 to 75 in 3 weeks of 10mg eitzimbe.

So what GLP do i take and how much?

I think a lot of cholesterol is related to particle size of LDL, which is small dense (bad) vs light fluffy (good). Way to know is to either measure them or simpler way to is look at TG:HDL ratio. Closer to one means more light fluffy LDL.

For instance my ratio is 1, but even though my ldl is 125, my calcium score is zero. Statins don’t do anything to small dense ldl so I stopped mine. Only think to lower the small dense is repatha etc

 

[Liter O' Test]

Most importantly, this can't be emphasized enough:

For best long term health outcomes, 120/70 is the most well substantiated target BP for the vast majority.

It's the lowest hanging health protection measure you can take, with the biggest bang for the buck by a long shot in terms of low effort/high reward. So stick with the trial and error until you find something that gets you to target with no intolerable sides. After that it's one daily pill that you usually don't have to change for years or decades.

With BP meds in general when initiating treatment or changing dose or compound:

It takes 2 weeks to reach the maximum; stable reduction in BP.

It takes a month for the body to acclimate, and side effects to subside (the ones that will subside). Fatigue, occasional light dizzyness, and water retention in the extremities are the most common initially experienced with almost all BP meds until things stabilize. Many people give up prematurely and end up living with "the silent killer" instead. Reassess after a month.

If you're not getting there with 40mg Telmisartan, or any monotherapy BP med, the best strategy is not to increase the dose, which increases the risk and severity of side effects, but to switch to combination therapy of two low dose meds that reduce BP using different mechanisms.

For instance, instead of increasing Telmisartin from 40mg to 80mg, use generic Twynsta, a combination of Amlodipine (a calcium channel blocker) and Telm (An angiotensin blocker) at 5mg Amlodipine / 40mg Telmisartin. That combo has less likelihood of sides than 80mg Telm (or 10mg Amlodipine) while resulting in significantly more BP reduction than either med used alone at double the dose.

All of the "-artan" ARB class BP meds offer advantages and disadvantages. Telmisartan offers more visceral fat reduction, while Valsartan has a more positive effect on libido and sexual function, for instance. Telmisartan improves muscle function, Valsartan improves aerobic performance. They're both banned PEDs in sports, BTW.

I've tried Amlodipine / Telmisartan which increased hair loss for me, so switched to Amlodipine / Valsartan, and not only did the hair loss stop, I love the way the way it makes me feel. That was completely unexpected.

Both one pill combos, 5/80 Twynsta and 5/160 ExForge (the Aml/Valsartan combo brand name) brought me from 160/93 to a rock solid 120/70. (fyi ignore the dosages of different drugs even in the same class. 80mg Telm and 160mg Val are roughly equivalent for instance, there are charts that show equivalent doses to guide you when switching).

If you haven't already, get a home monitor, they're cheap, and keep an eye on your BP closely when trying a new BP med.

Finally, while Telm is widely available from UGL suppliers, it's not difficult to find any of the combo meds from India pharma and easily acquireable in the US with a quick $40 telemedicine call and just telling the provider you had been on (FILL IN BP MED HERE), it was working, but you lost your insurance, and need a prescription so you can get back on it. Use GoodRx to find the pharmacy with cheapest price before the appointment.

what do you think are some side benefits of calcium channel blockers?

would the increase in blood flow/vasodilation reduce the risk of thromboembolic events?

 

[Ghoul]

what do you think are some side benefits of calcium channel blockers?

would the increase in blood flow/vasodilation reduce the risk of thromboembolic events?

Calcium channel blockers dilate your urethra, allowing for freer flow when urinating, offsetting the diminishing flow from BPH the majority of men get over time, that the DHT were exposed to with steroid use worsens.

No it doesn't make thrombotic events more likely, because blood had a greater velocity when vessels are constricted, and more force combined with smaller channels makes it more, not less likely to happen. Also, elasticity is improved with CCB, so a blockage is more likely to be resolved by the vessel stretching and the blocking material getting unstuck.

 

[Liter O' Test]

Calcium channel blockers dilate your urethra, allowing for freer flow when urinating, offsetting the diminishing flow from BPH the majority of men get over time, that the DHT were exposed to with steroid use worsens.

No it doesn't make thrombotic events more likely, because blood had a greater velocity when vessels are constricted, and more force combined with smaller channels makes it more, not less likely to happen. Also, elasticity is improved with CCB, so a blockage is more likely to be resolved by the vessel stretching and the blocking material getting unstuck.

have you read things about CCBs and the kidneys?

here is some evidence that increases in GFR observed after initiation of a DHP-CCB may not confer benefit on long-term renal outcome. In animal studies, DHP-CCBs produce an acute rise in GFR by causing afferent arteriolar vasodilation and loss of renal autoregulation.30-32 As a consequence, intraglomerular pressure typically rises, even when systemic arterial pressure falls.30,32 In contrast, ACEIs generally reduce intraglomerular pressure and do not interfere with autoregulation.30,32 These observations, taken together with clinical studies showing increases in proteinuria with DHP-CCBs, raise the possibility that pressure-mediated glomerular injury could contribute to the greater increase in proteinuria and more rapid decline in GFR observed in AASK participants receiving [CCBs].10,14,16,22,33,34

 

[Ghoul]

have you read things about CCBs and the kidneys?

here is some evidence that increases in GFR observed after initiation of a DHP-CCB may not confer benefit on long-term renal outcome. In animal studies, DHP-CCBs produce an acute rise in GFR by causing afferent arteriolar vasodilation and loss of renal autoregulation.30-32 As a consequence, intraglomerular pressure typically rises, even when systemic arterial pressure falls.30,32 In contrast, ACEIs generally reduce intraglomerular pressure and do not interfere with autoregulation.30,32 These observations, taken together with clinical studies showing increases in proteinuria with DHP-CCBs, raise the possibility that pressure-mediated glomerular injury could contribute to the greater increase in proteinuria and more rapid decline in GFR observed in AASK participants receiving [CCBs].10,14,16,22,33,34

Two decades later it's clear from the "Vast clinical experience" with Amlodipine that it's the "superior" choice for health outcomes, chronic kidney disease or not, especially when combined with another class of BP med:

"Use of dihydropyridine CCBs such as amlodipine (ALM) in patients with CKD is an attractive option not only for controlling BP but also for safely improving patient outcomes. Vast clinical experiences with its use as monotherapy and/or in combination with other anti-hypertensives in varied conditions have demonstrated its superior qualities in effectively managing HTN in patients with CKD with minimal adverse effects. In comparison to other counterparts, ALM displays robust reduction in risk of cardiovascular endpoints, particularly stroke, and in patients with renal impairment. ALM with its longer half-life displays effective BP control over 24-h, thereby reducing the progression of end-stage-renal disease. In conclusion, compared to other classes of CCBs, ALM is an attractive choice for effectively managing HTN in CKD patients and improving the overall quality of life."

Reno protective role of amlodipine in patients with hypertensive chronic kidney disease - PMC

Chronic kidney disease (CKD) and hypertension (HTN) are closely associated with an overlapping and intermingled cause and effect relationship. Decline in renal functions are usually associated with a rise in blood pressure (BP), and prolonged ...

www.ncbi.nlm.nih.gov

 

[Liter O' Test]

Two decades later it's clear from the "Vast clinical experience" with Amlodipine that it's the "superior" choice for health outcomes, chronic kidney disease or not, especially when combined with another class of BP med:

"Use of dihydropyridine CCBs such as amlodipine (ALM) in patients with CKD is an attractive option not only for controlling BP but also for safely improving patient outcomes. Vast clinical experiences with its use as monotherapy and/or in combination with other anti-hypertensives in varied conditions have demonstrated its superior qualities in effectively managing HTN in patients with CKD with minimal adverse effects. In comparison to other counterparts, ALM displays robust reduction in risk of cardiovascular endpoints, particularly stroke, and in patients with renal impairment. ALM with its longer half-life displays effective BP control over 24-h, thereby reducing the progression of end-stage-renal disease. In conclusion, compared to other classes of CCBs, ALM is an attractive choice for effectively managing HTN in CKD patients and improving the overall quality of life."

Reno protective role of amlodipine in patients with hypertensive chronic kidney disease - PMC

Chronic kidney disease (CKD) and hypertension (HTN) are closely associated with an overlapping and intermingled cause and effect relationship. Decline in renal functions are usually associated with a rise in blood pressure (BP), and prolonged ...

www.ncbi.nlm.nih.gov

So if my systolic is high and my dis is normal/low I should take alm? I don't even think I need an ARB right now. I don't see people just on alm.

 

[Ghoul]

So if my systolic is high and my dis is normal/low I should take alm? I don't even think I need an ARB right now. I don't see people just on alm.

You may not see it, but it's one of the, if not the, most common BP monotherapy drugs in the world. The most widely used, the most widely studied.

"Results Amlodipine has good efficacy and safety, in addition to strong evidence from large randomised controlled trials for cardiovascular event reduction.

Conclusions Amlodipine should be considered a first-line antihypertensive agent."

Amlodipine in hypertension: a first-line agent with efficacy for improving blood pressure and patient outcomes

Objectives Hypertension is well established as a major risk factor for cardiovascular disease. Although there is undeniable evidence to support the beneficial effects of antihypertensive therapy on morbidity and mortality, adequate blood pressure management still remains suboptimal. Research...

openheart.bmj.com

 

[lukiss96]

No to bash the drug or it's effectiveness - amlodipine. But personally I would not even consider it unless my life depended on it. Most common reported side effect - water retention. No thanks, enough of that from Testosterone already.

Telmisartan works good so far, keeps me in 130's/60's. From what I read and I talked to few docs too they say the same is keeping blood pressure under 140 is the goal on medication. When I'm ready for TRT protocol and further downsizing myself, I believe I'm gonna be just fine and have normal and healthy BP.

 

[Ghoul]

No to bash the drug or it's effectiveness - amlodipine. But personally I would not even consider it unless my life depended on it. Most common reported side effect - water retention. No thanks, enough of that from Testosterone already.

Telmisartan works good so far, keeps me in 130's/60's. From what I read and I talked to few docs too they say the same is keeping blood pressure under 140 is the goal on medication. When I'm ready for TRT protocol and further downsizing myself, I believe I'm gonna be just fine and have normal and healthy BP.

It only affects 10% of people who take it (hasn't happened to me after a decade of use) and quickly resolves when stoped. Hardly a reason to refuse to ever take one of the most effective BP meds in existence.

 

[lukiss96]

It only affects 10% of people who take it (hasn't happened to me after a decade of use) and quickly resolves when stoped. Hardly a reason to refuse to ever take one of the most effective BP meds in existence.

Could be, also I think most patients who take this medication have suboptimal diet compared to ours. Which leads to weight changes and retention of water.

I guess you have to find what works for you at the end of the day. There is no best, since everyone is different and therefore reacts diffefently. Best for you, now that's the right word.

 

[Liter O' Test]

No to bash the drug or it's effectiveness - amlodipine. But personally I would not even consider it unless my life depended on it. Most common reported side effect - water retention. No thanks, enough of that from Testosterone already.

Telmisartan works good so far, keeps me in 130's/60's. From what I read and I talked to few docs too they say the same is keeping blood pressure under 140 is the goal on medication. When I'm ready for TRT protocol and further downsizing myself, I believe I'm gonna be just fine and have normal and healthy BP.

130s /60s is where I'm at now and I'm not cool with it. The old way of thinking doctors had was 140 is hypertension, which is bullshit because that's like 20% higher than 120, which is significant. 120 or even a bit lower is best. Just like blood sugar ranges. It's not about what's healthy is about averages and not doing anything until absolutely required.

It just goes back to doctors never doing preventative care. Keep someone in the 130s putting stress on every organ or "eat less sodium" bullshit. Doctors goal is just to keep you alive.

I mean if you're 130s, then what is it when you're lifting or when you're walking around?

My heart rate and BP were ignored all throughout my 20s because stupid doctors literally just saw I was young and figured I'd survive or I'm too young for it or whatever b.s they have. Aren't they supposed to be objective with science?

I was nearly tachycardic my 20s and they would literally just see my readings and rip the cuff off and make some excuse. Especially with the the dial, I swear they don't even know how to read it and just say yup.youre good.

They'd literally write down different numbers from what they measured 120/80 70 bpm my ass

 

[Ghoul]

Could be, also I think most patients who take this medication have suboptimal diet compared to ours. Which leads to weight changes and retention of water.

I guess you have to find what works for you at the end of the day. There is no best, since everyone is different and therefore reacts diffefently. Best for you, now that's the right word.

Pretty much, that's why there are dozens of BP meds in use, and hundred+ combos.

For instance, even in people with edema from amlodipine, taking it as a combo with telmisartin often resolves the edema.

Seriously a reason to celebrate when you find what resolves your BP with no side effects.

 

[lukiss96]

130s /60s is where I'm at now and I'm not cool with it. The old way of thinking doctors had was 140 is hypertension, which is bullshit because that's like 20% higher than 120, which is significant. 120 or even a bit lower is best. Just like blood sugar ranges. It's not about what's healthy is about averages and not doing anything until absolutely required.

It just goes back to doctors never doing preventative care. Keep someone in the 130s putting stress on every organ or "eat less sodium" bullshit. Doctors goal is just to keep you alive.

I mean if you're 130s, then what is it when you're lifting or when you're walking around?

My heart rate and BP were ignored all throughout my 20s because stupid doctors literally just saw I was young and figured I'd survive or I'm too young for it or whatever b.s they have. Aren't they supposed to be objective with science?

I was nearly tachycardic my 20s and they would literally just see my readings and rip the cuff off and make some excuse. Especially with the the dial, I swear they don't even know how to read it and just say yup.youre good.

They'd literally write down different numbers from what they measured 120/80 70 bpm my ass

It's not always like that. Yes, their goal is to keep you alive and yes they do care about you. Unless we are talking specifically about those who do it only for money.

It's still much better to walk at 130's than say 160's systolic. It's about minimizing the damage. Nobody is saying 130 is perfect, keeping it closer to 110 would be ideal. They say you can't feel blood pressure and that it's the silent killer. I can say that I feel the difference and I feel better at 130's vs 150's before meds. I'm happy about it for now, it's not ideal but significantly better than it used to be.

I will strive for the better of course, I'm not saying this is it. Goal is of course 120's range and hopefully via losing more weight and some lifestyle changes in the near future without adding in more meds or increasing the dose.

 

[Liter O' Test]

Pretty much, that's why there are dozens of BP meds in use, and hundred+ combos.

For instance, even in people with edema from amlodipine, taking it as a combo with telmisartin often resolves the edema.

Seriously a reason to celebrate when you find what resolves your BP with no side effects.

I'm gonna give 2.5mg alm a shot right now 136/70. If only I could reduce heart rate without affecting my brain chemicals with a bets blocker

Thank you sincerely, you've helped me and I'm sure future people reading this

 

[Ghoul]

I'm gonna give 2.5mg alm a shot right now 136/70. If only I could reduce heart rate without affecting my brain chemicals with a bets blocker

See how it goes for a few weeks to allow yourself to adjust. Most sides and fatigue resolve by then. It should feel like "nothing" when it's working well for you.

 

[Liter O' Test]

See how it goes for a few weeks to allow yourself to adjust. Most sides and fatigue resolve by then. It should feel like "nothing" when it's working well for you.

I didn't realize it at the time but I had mental sides from metropolol, I know nebivol is more selective but I'm still worried about it. I did not like how I was on the beta blocker. Took my anxious energy away and made me apathetic.

85 at rest is no good though.

Thank you like I edited in my previous comment.

 

[Tbaz192]

Appreciate yall, just read this whole thread and opened my eyes up to other options!!!!

My doc, every time I’d go in my BP was in the 130s+ ( oh you’re fine just a tad high)
On cycle it would push 145+… realized that. Like damn. That’s bad. I felt like my heart was working so hard just sitting around,

So I picked up some telm. Night and day difference. After 2-3 weeks I felt less fatigued all around, my BP went down on cycle to 125-135 bpm depending on caffeine and what time I took the measurement.
Still being in the 130’s I lowered my stimulants. Dropped closer to 120’s

Telm seems to be working great. But now if I need other options I have the ones spoken about here.
On cycle I take 60mg might bump to 80mg at night. (Also makes me fall asleep fast)
On TRT. I take 30mg. Seems to be good.

Also… should I be changing doses based on what I’m doing? Bumping dose up on cycle and then dropping it a few weeks post cycle.
Or should I stay at the same dose year round?
Havent noticed anything bad lowering it.

 

[Liter O' Test]

Appreciate yall, just read this whole thread and opened my eyes up to other options!!!!

My doc, every time I’d go in my BP was in the 130s+ ( oh you’re fine just a tad high)
On cycle it would push 145+… realized that. Like damn. That’s bad. I felt like my heart was working so hard just sitting around,

So I picked up some telm. Night and day difference. After 2-3 weeks I felt less fatigued all around, my BP went down on cycle to 125-135 bpm depending on caffeine and what time I took the measurement.
Still being in the 130’s I lowered my stimulants. Dropped closer to 120’s

Telm seems to be working great. But now if I need other options I have the ones spoken about here.
On cycle I take 60mg might bump to 80mg at night. (Also makes me fall asleep fast)
On TRT. I take 30mg. Seems to be good.

Also… should I be changing doses based on what I’m doing? Bumping dose up on cycle and then dropping it a few weeks post cycle.
Or should I stay at the same dose year round?
Havent noticed anything bad lowering it.

You don't want it too low or too high.. so adjust based on what you're doing..
Also nicotine raises bp

 

[Ghoul]

Appreciate yall, just read this whole thread and opened my eyes up to other options!!!!

My doc, every time I’d go in my BP was in the 130s+ ( oh you’re fine just a tad high)
On cycle it would push 145+… realized that. Like damn. That’s bad. I felt like my heart was working so hard just sitting around,

So I picked up some telm. Night and day difference. After 2-3 weeks I felt less fatigued all around, my BP went down on cycle to 125-135 bpm depending on caffeine and what time I took the measurement.
Still being in the 130’s I lowered my stimulants. Dropped closer to 120’s

Telm seems to be working great. But now if I need other options I have the ones spoken about here.
On cycle I take 60mg might bump to 80mg at night. (Also makes me fall asleep fast)
On TRT. I take 30mg. Seems to be good.

Also… should I be changing doses based on what I’m doing? Bumping dose up on cycle and then dropping it a few weeks post cycle.
Or should I stay at the same dose year round?
Havent noticed anything bad lowering it.

I don't think you should be changing it, as long as your BP doesn't drop too low.

It takes time for your body to become accustomed to a stable level, that's why sides are worst when initiating a new med or changing dose.

Nothing to be gained by reducing the dose off cycle imo, and you're adding stress by varying the dose.

 

[Iamnatty]

I didn't realize it at the time but I had mental sides from metropolol, I know nebivol is more selective but I'm still worried about it. I did not like how I was on the beta blocker. Took my anxious energy away and made me apathetic.

85 at rest is no good though.

Thank you like I edited in my previous comment.

Do you do cardio ? High heart rate cardio has lowered my resting heart rate