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

[Liter O' Test]

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

ive had a high resting heart rate since 19-21 years of age. I think its gotten lower over the years from the gear making my heart bigger. Used to be 90s at rest, now its low 80s at rest. Ive done 25-40 miles per week and i dont think it was significant. I think the symptoms are related to my nervous system

 

[explodingHeart]

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.

Can you share/paste all of your notes on blood pressure and GLPs?

Especially in regards to GLP and vascular health?

Frontiers | GLP-1 Receptor Agonists and Coronary Arteries: From Mechanisms to Events

Objective: Glucagon-like peptide 1 receptor agonists (GLP-1 RAs) lower plasma glucose through effects on insulin and glucagon secretion and by decelerating g...

www.frontiersin.org

 

[TRENdy07]

PCT24x7 has Telmaheal AM, 5mg Amlodipine / 40mg Telmisartin, a low dose "Step 1" treatment recommended in the charts above for anyone with BP over 150/90 (either).

It has a 72% chance of getting a patient below 130/80, so at or close to the 120/70 target.

$43 for a year's worth.

How do I order from there? I search the med but can’t click on anything?

 

[Liter O' Test]

How do I order from there? I search the med but can’t click on anything?

 

[TRENdy07]

View attachment 288788

I went to pct 24x7, I searched and found telmaheal am on a list… there wasn’t a link to click on for the product and no way to add to a cart

 

[HB_22]

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.

This is not the case. Please link some medical research papers.

Here is what CCBs actually do: they worsen symptoms, especially for people with BPH.

Calcium channel blockers (CCBs) are commonly used antihypertensive medicines [1], and are associated with the development of lower urinary tract symptoms (LUTS) [2,3,4,5]. This occurs as a result of its interference with bladder contraction [6,7,8].

Role of calcium channel blockers in lower urinary tract symptoms in benign prostatic hyperplasia: a literature review - African Journal of Urology

Background Benign prostatic hyperplasia (BPH) and the use of CCBs are common in older persons, and are also associated with lower urinary tract symptoms (LUTS). This review summarised and synthesised relevant information and recent advances to improve clinical knowledge on the role of CCBs in...

afju.springeropen.com

 

[lilhawk]

ive had a high resting heart rate since 19-21 years of age. I think its gotten lower over the years from the gear making my heart bigger. Used to be 90s at rest, now its low 80s at rest. Ive done 25-40 miles per week and i dont think it was significant. I think the symptoms are related to my nervous system

Some people run higher than others, low 80s is perfectly fine, as long as you're below 100 at rest you're good.

 

[Liter O' Test]

Some people run higher than others, low 80s is perfectly fine, as long as you're below 100 at rest you're good.

After 2 years of metropolol my heart rate is now low 80s, I think the beta blocker had an atleast, semi-permanent effect on my nervous system to keep my heart rate down after ceasing the medication.

im on clen now and using nebivolol, i should have used that from the start but I didnt want to mess with what was working at the time, prescribed by an ER doc and I had been out of bodybuilding for a few years.

 

[Liter O' Test]

This is not the case. Please link some medical research papers.

Here is what CCBs actually do: they worsen symptoms, especially for people with BPH.

Role of calcium channel blockers in lower urinary tract symptoms in benign prostatic hyperplasia: a literature review - African Journal of Urology

Background Benign prostatic hyperplasia (BPH) and the use of CCBs are common in older persons, and are also associated with lower urinary tract symptoms (LUTS). This review summarised and synthesised relevant information and recent advances to improve clinical knowledge on the role of CCBs in...

afju.springeropen.com

I tried 2.5mg Alm and even at that dose I had painful swelling in my feet after just one week.
I think it made me more vascular though.

 

[Ghoul]

This is not the case. Please link some medical research papers.

Here is what CCBs actually do: they worsen symptoms, especially for people with BPH.

Role of calcium channel blockers in lower urinary tract symptoms in benign prostatic hyperplasia: a literature review - African Journal of Urology

Background Benign prostatic hyperplasia (BPH) and the use of CCBs are common in older persons, and are also associated with lower urinary tract symptoms (LUTS). This review summarised and synthesised relevant information and recent advances to improve clinical knowledge on the role of CCBs in...

afju.springeropen.com

I'll just quote the unmentioned portion of the one you provided:

"In contrast, an animal study found Amlodipine to be associated with improved Lower Urinary Tract Symptoms in Benign Prostate Hyperplasia (enlarged prostate) rats."

Following the link to that study, we find they injected rats with Testosterone, inducing BPH, ie, prostate growth, blocking urinary flow just as happens to many steroid uers. The administration of Amlodipine blocks smooth muscle Calcium Channels, relaxing muscles that squeeze the urethra and obstruct urinary flow, making urination easier.

Which is precisely what I've experienced.

The meta-study you reference relies on casual observation of urinary problems among a largely sick, elderly population who happen to be on a common class of BP med. Lower Urinary Tract Symptoms encompass all sorts of problems, not just the blockage caused by BPH.

The Amlodipine study specifically looks at urination blockage caused by an enlarged prostate. It goes one step further with actual in vivo experimentation. Inducing an enlarged prostrate with steroids to the point urine flow is blocked, then relieving those symptoms with Amlodipine.

Direct, in vivo experimentation is recognized as higher quality evidence than casual associations, which is likely why the authors felt the need to mention this study, one that's entirely dissimilar from the others they used, but of too much significance to ignore.

 

[Sector]

kind of unrelated (don't mean to hijack the thread) but rather than creating a new thread for a rather simple question i thought i would just post here where we are discussing medications.

For those that use a beta blocker: any major difference between propanolol and nebivolol?

Thinking of adding some low dose propanol for reductions in RHR, and hopefully for sleep at night. I know a lot of people swear by nebivolol though

 

[Supertrain]

This thread has convinced me it’s time to start Telmisartan to get my BP normalized. Also thinking of adding 2.5mg Tadalafil to address BP and help with workouts. Where are people sourcing Telmisartan? I see PCT.zone but curious if others are better priced or domestic.

After years of doc telling me to lose weight to lower BP I actually lost the weight (Tirz annd now Eeta) but my BP is still high, averaging 135/87. Lowers to 120/80 after 40+ minutes of cardio, stays normal for a few hours.

LDL and VLDL are quite low now, HDL normal. I saw @Ghoul and @Theworm discussing possible reversal of calcium buildup and I’m curious for more info about how to try that using PCSK9 inhibitors, do you have any more info on that or suggestions on how to approach/dose?

 

[Ghoul]

This thread has convinced me it’s time to start Telmisartan to get my BP normalized. Also thinking of adding 2.5mg Tadalafil to address BP and help with workouts. Where are people sourcing Telmisartan? I see PCT.zone but curious if others are better priced or domestic.

After years of doc telling me to lose weight to lower BP I actually lost the weight (Tirz annd now Eeta) but my BP is still high, averaging 135/87. Lowers to 120/80 after 40+ minutes of cardio, stays normal for a few hours.

LDL and VLDL are quite low now, HDL normal. I saw @Ghoul and @Theworm discussing possible reversal of calcium buildup and I’m curious for more info about how to try that using PCSK9 inhibitors, do you have any more info on that or suggestions on how to approach/dose?

The cheapest way is to get an appointment for GoodRX Care. Join "Gold" which is free for the first month (after $10/mo but you can just cancel). That makes a virtual appointment $19.99.

Look up the GoodRx price for 90 tablets of Telmisartan 80, It'll be $25-30. Also look up 90 tablets of 5mg Tadalafil. It'll be $20-25. Decide which pharmacy near you has the best deal.

**********
On your appointment tell them:

-I have hypertension, Around 135/85, and erectile dysfunction.

-They were well controlled with 80mg Telmisartan and 5mg daily Cialis.

-I lost my health insurance (job loss), and need refills for both. Could you please prescribe 90 of each because it's a lot cheaper that way.

They'll ask which pharmacy to fill them, and that's it. Should be 5 mins.

***********.

You now have 6 months of FDA approved Telmisartin (40mg is the starting dose) and 2.5mg Tadalafil for about $50+$20 appointment, so $12 a month for both.

You can repeat this every 90 days if you want to build up a stash.

Get yourself a pill cutter($5) and a digital blood pressure monitor($30)

 

[Sampei]

For anyone wanting more detail on how to choose what to use, this is a flowchart based on the most up to date guidelines. Doctor's have long used these, but more recently they have computer programs that look at a ton of factors and spit out a recommendation, the doctor updates it with the results at the next appointment, and it suggests changes if needed. It's very "step by step" until something works.

Note one of the biggest changes recently is that if you're over 150 systolic OR 90 diastolic they now recommend starting with a 2 combo med, ie, an ARB and a Calcium Channel Blocker. If it's not enough go from low to moderate dose. If that's not enough either go to the high dose (only if you have no side effects) or, preferably add a 3rd med (a diuretic) to the combo.

(this multi drug, low dose strategy has proven so effective, and with less side effects than high doses, there are a number of quad bp drug class combo pills coming to market, though that's not a step in the charts yet)

If you have minor side effects but your BP is being effectively lowered, from what I've read it's good practice to keep using that same class combination (ie calcium channel blocker/ARB), but change one of the two drugs in the combo and use an equivalent dose to what's working.

Flowchart:

UpToDate

www.uptodate.com

Medication selection chart:

UpToDate

www.uptodate.com

Original source:

UpToDate

www.uptodate.com

Why there is no nebivolol suggested in the chart? But there is amlodipine when nebivolol is considered better and with less side effect.

Am I wrong? What's best to reduce HHR?

What would it be a 5mg equivalent amlodipine with nebivolol? 5mg?

 

[Theworm]

This thread has convinced me it’s time to start Telmisartan to get my BP normalized. Also thinking of adding 2.5mg Tadalafil to address BP and help with workouts. Where are people sourcing Telmisartan? I see PCT.zone but curious if others are better priced or domestic.

After years of doc telling me to lose weight to lower BP I actually lost the weight (Tirz annd now Eeta) but my BP is still high, averaging 135/87. Lowers to 120/80 after 40+ minutes of cardio, stays normal for a few hours.

LDL and VLDL are quite low now, HDL normal. I saw @Ghoul and @Theworm discussing possible reversal of calcium buildup and I’m curious for more info about how to try that using PCSK9 inhibitors, do you have any more info on that or suggestions on how to approach/dose?

Yes, get on repatha. Tell them you were on a statin but you can’t tolerate them, too much muscle pain, and get a script for repatha. I do once a month dosing myself and my insurance won’t pay but I pay cash 300 a month. Cheaper than my cell phone bill

 

[Ghoul]

Why there is no nebivolol suggested in the chart? But there is amlodipine when nebivolol is considered better and with less side effect.

Am I wrong? What's best to reduce HHR?

What would it be a 5mg equivalent amlodipine with nebivolol? 5mg?

Neither is really better than the other, but they aren't interchangeable either.

These are two entirely different classes of BP meds, with different mechanisms of action and side effects. Amlodipine is a calcium channel blocker that relaxes heart muscles and blood vessels, causing them to open wider and allow blood to flow more easily. Nebivolol is a beta blocker, only slowing the heart.

All AAS use increases angiotensin, so constriction of blood vessels is definately an underlying cause of high blood pressure, as well as being the primary "natural" cause of high blood pressure. Some AAS also boost adrenaline, increasing heart rate, another potential cause, which is where a beta blocker can help.

Neither of these seems particular good by themselves, and combinations seem to offer the lowest sides and best outcomes.

In fact, Amlodipine/Nebivolol has recently been identified as an effective and safe combination to lower BP in certain people.

The most up to date hypertension treatment guidance recommends starting with small dose combinations of something to block Angiotensin, along with a calcium channel blocker, to open blood vessels as much as possible. Then add a beta blocker if specific symptoms like chest pain, irregular heartbeat continue. Beta blockers are never a first choice treatment for high BP.

 

[Sampei]

Neither is really better than the other, but they aren't interchangeable either.

These are two entirely different classes of BP meds, with different mechanisms of action and side effects. Amlodipine is a calcium channel blocker that relaxes heart muscles and blood vessels, causing them to open wider and allow blood to flow more easily. Nebivolol is a beta blocker, only slowing the heart.

All AAS use increases angiotensin, so constriction of blood vessels is definately an underlying cause of high blood pressure, as well as being the primary "natural" cause of high blood pressure. Some AAS also boost adrenaline, increasing heart rate, another potential cause, which is where a beta blocker can help.

Neither of these seems particular good by themselves, and combinations seem to offer the lowest sides and best outcomes.

In fact, Amlodipine/Nebivolol has recently been identified as an effective and safe combination to lower BP in certain people.

The most up to date hypertension treatment guidance recommends starting with small dose combinations of something to block Angiotensin, along with a calcium channel blocker, to open blood vessels as much as possible. Then add a beta blocker if specific symptoms like chest pain, irregular heartbeat continue. Beta blockers are never a first choice treatment for high BP.

I stated that I'm interested in HR reduction primarly, my BP is perfect on 40mg telmisartan but my HR isn't so started adding 2.5mg nebivolol and probably gonna raise it to 5mg cuz at 2.5mg it's still too high.

Is this a reasonable approach?

Both medication have the least side effect for what I have read so that's why I chose these two

 

[Ghoul]

I stated that I'm interested in HR reduction primarly, my BP is perfect on 40mg telmisartan but my HR isn't so started adding 2.5mg nebivolol and probably gonna raise it to 5mg cuz at 2.5mg it's still too high.

Is this a reasonable approach?

Both medication have the least side effect for what I have read so that's why I chose these two

There are so many combinations out there that often it takes a lot of experimentation to determine what works best for an individual, with the least sides.

If that combo gives you ideal BP and heart rate, with tolerable sides, it's a good solution in your case.

The reason I believe they tackle blood pressure before high heart rate is because healthy blood vessels can compensate for a higher heart rate without pushing you into high blood pressures. In other words, if you have a high heart rate with high BP, your cardiovascular system has a problem, basically, angiotensin or calcium commanding your blood vessels to constrict, or they've permanently hardened and unable to stretch to compensate.

 

[Sampei]

There are so many combinations out there that often it takes a lot of experimentation to determine what works best for an individual, with the least sides.

If that combo gives you ideal BP and heart rate, with tolerable sides, it's a good solution in your case.

The reason I believe they tackle blood pressure before high heart rate is because healthy blood vessels can compensate for a higher heart rate without pushing you into high blood pressures. In other words, if you have a high heart rate with high BP, your cardiovascular system has a problem, basically, angiotensin or calcium commanding your blood vessels to constrict, or they've permanently hardened and unable to stretch to compensate.

I have perfect BP with very high HR xD
without telmi I had 125/75 on cycle
but HR is 98-100

 

[Ghoul]

I have perfect BP with very high HR xD
without telmi I had 125/75 on cycle
but HR is 98-100

FYI, in line with the most recent evidence of long term good health outcomes, 120-129/70-79 is now considered "Elevated" and consideration of treatment should start in that range. So if raising nebivilol gets you below that (and you're not passing out), it's actually preferable

New ESC Guidelines on BP and Hypertension Shift Treatment Targets Lower

The recommendations, based on STEP, CRHCP, and ESPRIT data, are now more in line with US guidance.

www.tctmd.com