#148

Tim, why not add an SGLTi like dapa or empagliflozin? You’d get all the potential health benefits along with at least some additional drop of BP.

2 Likes
#149

@Davin8r,

Thanks for the recommendation. Yes, these meds sound attractive but the potential sides give me pause:

“The main adverse events of SGLT2i include urinary tract and genital infections, as well as euglycemic diabetic ketoacidosis. Concerns have also been raised about the association of SGLT2i with lower limb amputations, Fournier gangrene, risk of bone fractures, female breast cancer, male bladder cancer, orthostatic hypotension, and acute kidney injury.”

Now this may be a lawyer talking, doing a nice job of CYA. Plus, I don’t have diabetes, so most of the warnings probably don’t apply to me. I’ll talk to one of my docs about it. It could be just the thing.

1 Like
#150

That’s the position I’m taking for myself – that the scary sounding side effects are not only extremely rare, but even more extremely rare in a non-diabetic. If you haven’t read through the thread titled “Canagliflozin – another top anti-aging drug”, the published studies on the safety of these meds are very reassuring to me, and the potential health benefits appear to be enormous.

4 Likes
#151

Last time I checked nifedipine it was inferior to amlodipine. And its 2h half-life is way too short to ensure good BP control over 24h. Carvedilol is interesting but I think it lowers heart rate and mine is already in the lower range of normal.

Hibiscus tea: interesting but not convenient when traveling.

3 Likes
#152

Telmisartan Reduces LPS-Mediated Inflammation and Induces Autophagy of Microglia 2024

We conclude that telmisartan has unique properties relative to other ARBs, including potent anti-inflammatory actions and an induction of microglial autophagy, which may enable specific therapeutic uses.

Comparative efficacy and safety of six angiotensin II receptor blockers in hypertensive patients: a network meta-analysis 2024

This study aimed to evaluate the efficacy and safety of six ARBs (losartan, valsartan, irbesartan, telmisartan, candesartan, and olmesartan) commonly used to treat hypertension, using a network meta-analysis.
Valsartan and losartan were less effective in lowering blood pressure than other drugs, with no significant differences. Olmesartan and telmisartan were associated with fewer AEs than losartan, although the incidence of adverse events was similar between the other blockers. Olmesartan and telmisartan demonstrated the best balance of antihypertensive efficacy and minimal adverse events. More research is needed to confirm whether telmisartan and olmesartan are optimal choices for controlling blood pressure in patients.

9 Likes
#153

New Aktiia paper by the Aktiia team: Optimizing time-in-target-range assessment for blood pressure: insights from a large-scale study with continual cuffless monitoring

Blood pressure (BP) time-in-target-range (TTR) is an emerging predictor of cardiovascular risk. Conventional BP methods are fundamentally unable to provide an optimal assessment of TTR, using irregular measurements separated by lengthy intervals. We investigated the optimal duration and frequency for reliable, practical TTR assessment in clinical settings using continual monitoring.
This study demonstrated that TTR is markedly impacted by measurement frequency and duration, and that at least one week of 24-h continual monitoring was needed to classify TTR with 90% sensitivity. The contributions of frequency of measurements and duration of measurement were unequal. Even very frequent monitoring over the course of one 24-h period was not sufficient to calculate TTR reliably. Collecting the requisite number and density of measurements is practically achievable only with continual cuffless BP monitors that can generate datasets allowing for TTR classification in real-world clinical use.
Accuracy of ≥90% in TTR classification only occurred with 7 days of continual 24-h monitoring.

2 Likes
Blood Pressure monitors
我们应该达到的最佳血压目标是什么？收缩压低于 110 或 100？
#154

My watch notified me of a developing trend in my HRV. For the four years I have measurements on it it, the 30-90-180 day HRV means have been stable at ~46, which is a good but not great value for my age. When I reviewed the dataset, I saw that the upward trend currently in the 60’s corresponds with adding 40 mg. telmisartan to my regimen. I added this ARB to lower my high normal BP into the moderate-low range. As someone whose sympathetic response is above average, there are theoretical reasons why an ARB might increase HRV but I thought it interesting to observe that it might actually be having this effect. I have made no other notable changes in diet, exercise, or lifestyle during this period. The question remains as to whether this HRV increase represents a beneficial change or if it is better characterized as an unmasking of what I have reason to think is good underlying cardiac neurology formerly masked by an overactive sympathetic nervous system.

I’m curious to learn if others have seen changes in their HRV possibly related to ARBs.

4 Likes
#155

Can you say more about these two statements? I wonder if this applies to me too.

As someone whose sympathetic response is above average, there are theoretical reasons why an ARB might increase HRV

How do you know your sympathetic response is above average?

Why do you think an ARB would increase your HRV if you have an above average sympathetic response?

#156

I know a girl who drinks abut a pitcher a day and lowered her BP by 10 points.

I have labile hypertension on telmisartan, but I also had it on lisinopril. I think an amlodipine add-on is more stabilizing, but not at the lower doses.

1 Like
#157

That might lead to too high aluminum and manganese.

#158

A complete answer would require more time than I have before I have to travel @Barnabas. White Coat hypertension can be a common indicator of an exaggerated sympathetic response. There are many others for which, over a lifetime, one observes that their sympathetic system takes over when, objectively, there may be no need.

The theory and research discipline has yet to consolidate but if you Google terms like Telmisartan, HRV, blood pressure, ARBs, stress, sympathetic system, etc. you will uncover an interesting trail of research suggesting that HRV declines when parasympathetic/sympathetic control favors the latter and that stressors (both real physiological and perceived meditated by cognition) are associated with this condition (the actual causal chain can be comp[lex and run in both directions). This is why these two control systems are known as “rest and digest” and “fight or flee.”

If you precede your searches with “SITE: *.GOV” you will mostly retrieve research articles.

2 Likes
#159

Thanks

Still, another cheap intervention to try.

It has higher customer ratings on Amazon, not that it means anything, but most enjoy the tea.

It looks like there are studies to back up the benefits claims. Pub Med has many articles establishing its benefits

"Various review articles have highlighted other potential benefits of hibiscus tea, including:

Several studies have demonstrated the potential of hibiscus tea in lowering blood pressure:

A randomized controlled trial ([2]) found that consuming hibiscus tea for 6 weeks significantly reduced systolic blood pressure (SBP) by 7.2 mmHg compared to placebo in pre- and mildly hypertensive adults.

A systematic review and meta-analysis ([3]) showed a significant reduction in both systolic and diastolic blood pressure with hibiscus supplementation, with greater effects observed in individuals with higher baseline blood pressure levels.

Neuroprotective effects and potential benefits in Alzheimer’s disease ([1])

Nephroprotective, antianemic, antioxidant, anti-inflammatory, and anti-xerostomic activities ([5])

Potential therapeutic applications in cancer and inflammatory diseases ([6])

Antimicrobial and antioxidant activities

Several studies have suggested that hibiscus tea may have beneficial effects on lipid profiles:

A review article ([4]) indicated that hibiscus extracts can improve lipid profiles by reducing total cholesterol, LDL cholesterol, and triglycerides.

A review article ([5]) highlighted the antidyslipidemic effects of hibiscus preparations reported in clinical trials.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9033014/

1 Like
#160

It seems like a beta-blocker medication (rather than ARB or other BP med classes), especially a B-blocker with low side effects such as nebivolol, would be the ideal antidote for someone with an overly active sympathetic nervous system, since we’re directly targeting receptors for adrenaline/epinephrine. It’s strange to me why there isn’t more research specifically in this area.

2 Likes
#161

For the study @adssx cited Neuroglia | Free Full-Text | Telmisartan Reduces LPS-Mediated Inflammation and Induces Autophagy of Microglia
here is the mechanism summary of Telmisartan by Gemini:

Screenshot 2024-07-04 at 10.35.23 AM
Screenshot 2024-07-04 at 10.35.23 AM982×830 116 KB

2 Likes
#162

What dose did your mother take?

#163

On the Hawthorn she is taking the Healths Harmony Hawthorn 4:1 Extract, 1 capsule (665 mg concentrated from 2660 mg) daily.
The price is right - on Amazon 4 months for $15.

2 Likes
#164

Independent paper on Aktiia in the Journal of Human Hypertension: Wearable cuffless blood pressure tracking: when will they be good enough? 2024

To understand the challenges of currently accepted methods and cuffless devices, I performed a 24-h blood pressure monitoring self-test, including measurements when awake, asleep and watching an intense match of the Rugby World Cup final, with the purpose to demonstrate the challenges and opportunities we face. Blood pressure was monitored using five different devices simultaneously: validated left and right arm cuff blood pressure, and three cuffless wearable devices (wrist-band, chest patch and a ring). Whilst none of these devices proved to be perfect in capturing a physiologically challenging measure, namely blood pressure, it emphasised that our current practice of a single blood pressure measurement in clinical practice should be revisited.

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The Aktiia device (Fig. 1 Panel B) produced comparable systolic blood pressure when awake (p = 0.73) and during the rugby match (p = 0.54), but reported higher values when asleep (p < 0.001). This finding aligns with our previous independent comparison study in 41 patients.

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Where a patient can usually only endure one 24-h cuff-based blood pressure measurement at a time, cuffless devices are used for weeks and months without the user being aware that readings are taken. The benefit of weeks or months’ worth of data compared to a single 24-h period, is perhaps underestimated.

With blood pressure changing all the time, it is likely that when more readings are taken, it may be better than fewer. In fact, when reflecting on current clinical practice mostly relying on a single snapshot clinic blood pressure taken (often imprecisely) for decision-making, one cannot help but wondering whether it is time to completely overhaul how blood pressure is measured in primary care. Current blood pressure measurement practices across thousands of busy clinics is certainly not ‘good enough’—the question is when cuffless readings will be good enough?

3 Likes
我们应该达到的最佳血压目标是什么？收缩压低于 110 或 100？
Blood Pressure monitors
#165

Hawthorn has lowered my BP by ten points and counting.

With telmisartan 40 and amlodipine 5, I got my BP down to 123. Hawthorn bumped it down to 114. The ScienceDirect paper says it has been shown to be safe for up to two years. High BP can do some damage in two years.

3 Likes
#166

How long does it take for Telmisartan to lower BP? I’ve been on it for about a month and my BP is about the same.

#167

About 2 weeks. How do you measure your BP? How often? Which dose are you using?