#61

In longitudinal studies, from what I remember, people on telmisartan have 30% less AD and PD than people on other ARBs, who themselves have 20% less AD and PD than people on other antihypertensive.

So for telmisartan some effects are for sure independent of BP control. Telmisartan reduces insulin resistance and tumor necrosis factor alpha (TNF-alpha), it is a PPAR inhibitor and it clears alpha α-synuclein in some models.

There was a small trial of candesartan in people with PD. Most people with PD have optimal BP. They had to stop the trial early but found that candesartan significantly reduced apathy (a non motor PD symptom).

A larger trial of telmisartan in PD (normotensive) is about to start as well.

So I think we’ll soon have an answer to your question.

Also, I wonder how many people have “optimal” blood pressure: 24h average <115/75 mmHg, PP <40, MAP <90 and low BP variability. Maybe what actually matters is “Time spent above 120/80” and that if a 24h BP monitor (or better: one week with Aktiia) shows that you spend even 10% of the day above that threshold then taking a tiny dose of telmisartan (10 mg? 20 mg? might be good. This is just a guess. I don’t think paper has ever looked at this.

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#62

As women have more thyroid problems, it might explain why nebivolol decreased lifespan in female mice: The latest Interventions Testing Program (ITP) study Results

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#63

Thanks @adssx this is very helpful.

I was reading about some of the mechanisms like

Telmisartan reduces insulin resistance and tumor necrosis factor alpha (TNF-alpha), it is a PPAR inhibitor and it clears alpha α-synuclein in some models

In @DrFraser new block post that just came out (I believe you might have helped with, very good stuff: Bonus Second Blog - Neurocognitive Decline Series #3?

Please note that above conclusion is not “for sure”

As one example, it could be that the people on other ARBs are experiencing two effects:

  1. BP pressure is helping a LOT (for simplicity say 30%), but 2. something else with the medication is hurting the AD/AP outcome a bit (say 10%), and the net is the -20% effect.

While A. Teli is helping through a similar BP control extent but B. does not have those negative aspects and its net would be -30%.

So you still have that Teli minus ARB = 10% effect, while 100% of both meds’ effects were through the BP control.

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#64

The first measure has virtually always been the case for me. But you have convinced me to get more measurements and also to look into the other metrics.

Does anyone know if there is a solution yet for how to use an EU Aktia in the US on iPhone/iOS?

@RapAdmin did you look into that a while back?

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#65

Tel minus other ARBs is 30%, not 10% (actually 28%: Angiotensin Receptor Blockers and Cognition: a Scoping Review 2023: “By leveraging the National Health Insurance Research Database, a Taiwanese study [78] found that the dementia risk was lower in telmisartan users compared with other ARB users (hazard ratio, 0.72; 95% CI, 0.53 to 0.97; p = 0.030). The authors attributed this to the greater effect of telmisartan on increasing PPAR-γ expression.”)

So yes potentially all other ARBs have some terrible side effect. But realistically, given the numbers, it’s more likely that only telmisartan has something particular.

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#66

Good that you agree - given that, I hope you also agree it is not good to tell thousands of people who may read your post that the longitudinal data => for sure independent of BP control.

It is the “for sure” part that we have to be very careful with in medicine. In this case longitudinal data with your ASSUMPTIONS (not stated) do note meet a hierarchy level of “for sure” as you stated it:

That was all that I was trying to point out.

Btw re, this new statement,

Is not a fair way to frame things. The numbers you provided yourself are:

So the people would not experience “some terrible side effect” as you frame it (to belittle my comment to you and “win a debate”?).

Rather they would according to your data have a 20% “positive side-effect” that may be a mix of one positive effect that is bigger than one smaller side-effect. The patients and their doctors would only see the net positive effect - so that comment of yours is fudging what your own data says and not a constructive way to discuss and figure things out together.

Thanks for clarifying how much the extent that Tel was better for AD/PD than other ARBs in that data, I did not understand the effect was that big and had incorrectly read that part of your post.

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#67

What’s going on with you?! Please assume good intent. I wrote: “So for telmisartan some effects are for sure independent of BP control. Telmisartan reduces insulin resistance and tumor necrosis factor alpha (TNF-alpha), it is a PPAR inhibitor and it clears alpha α-synuclein in some models.” What is wrong with that? What are you trying to say?

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#68

Exactly, it’s nice to assume good intent (or no bad intention personally) until proven multiple times. Tone in text can’t be read many times either…

Doesn’t it say in the next sentence that it isn’t probably what isn’t going on…

But I probably shouldn’t read into this too much, I am getting already confused.

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#69

@adssx and @AnUser Ok, I agree with that. and should not have included the parenthesis question (even if it truly felt that way to me, I was not constructive to write out that question in the way I did).

That it is wrong to say “for sure” after doing some math on two longitudinal data sets, when other scenarios cannot be ruled out and “for sure” is too confident.

That is more ok to say. But that is from his response back to me where the framing had changed, not the original email with the “for sure” language that I commented on and then in turn was getting push back on. Probably or more likely might still be a too strong read based on the data that was provided if you ask me, but probably or more likely is fundamentally different than for sure as it does show that there are questions marks and that there is some uncertainty.

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#70

@Neo, apologies accepted. I know you’re a good person, so I don’t take it personally :slight_smile:

This is precisely what I wrote, listing the BP-independent effects. It’s true that the “So” and the previous paragraph (about longitudinal studies) can make readers believe that it’s a conclusion. But I posted that at 7:35am while on the toilet (sorry for the details): can’t ask too much from me :sweat_smile:

Still, given the HR, I don’t understand how it could be linked to BP. Either telmisartan has some additional BP-independent positive effect, or other ARBs have some BP-independent negative effect. Correct?

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#71

That is their, adssx, probability assessment, I mean you can argue against it and try to change someone’s probability or just accept it, doesn’t really matter that much. If someone is off the mark on the probability all the time then that is good info but the trend matters more than anything. Meaning it is not necessary to try and correct someone if someone seems to set a probability that is off 10%-20% of the time, or something.

By the way when talking about someone else in a conversation it is probably nicest to say their name or username and not “he” or “she”, or whatever.

#72

The main point throughout has been around the following, can you please help clarify as I thought we had aligned and then from your last message I’m no longer sure.

You later said *“more likely”. Do you agree that that is a better way to characterize the level of certainty / can we agree that “for sure” based on longitudinal data you provided is too strong or are you saying that you believe “for sure” based on longitudinal data is actually correct?

#73

Again, this is what I wrote:

So for telmisartan some effects are for sure independent of BP control. Telmisartan reduces insulin resistance and tumor necrosis factor alpha (TNF-alpha), it is a PPAR inhibitor and it clears alpha α-synuclein in some models.

The “for sure” relates to “some effects” and these effects are listed after (insulin sensitivity, PPAR-γ inhibition, etc.).

#74

Your selective selection of this part of your message to quote and focus on is not fair:

You are cutting out the whole sentence that “So” connects to.

“So” connects back to something - not forward to something.

You should include the top part also in here if you want to have a accurate representation of the issue.

Do you agree that “So” is referring back to what you said before “So” and especially that that is how many people would read or at least would risk reading it since that is language wise what it actually says?

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#75

I’ve already addressed this here in my previous answer:

#76

Ok, that is all this was about - that “So… for sure” in the context of optimal blood pressure was too strong certainty/conclusion.

Now, onward and upward!

On my end, I’ll read up more on whether someone with optimal BP would benefit from Tel and what risks might be (and will try and get an Aktiia from Europe to stress test whether my BP in fact is optimal or not).

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#77

Re: using EU Aktiia in USA:
I purchased the EU Aktiia and have been able to activate it in the USA with the following steps (for Android; hpefully IOS similar):

  1. Download free VPN APP such as Windscribe
  2. Create new google account; log in to that
  3. Activate German VPN
  4. Download Aktiia APP from new Google login and from within Germany VPN
  5. Activate bracelet through App.
  6. I was then able to log back into my normal Google account on my phone, and the App continues to work fine.

As an aside, Aktiia says they will be rolling out the bracelet in the USA in 2025

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Has Anyone Seen a Rise in Blood Pressure Using Rapamycin?
#78

Jeesh. This reminds other debates with @anuser and others on different topics in this forum.

No one is asking you to take telesmartan! If you think that there is a superior ARB take that instead!

Most self-prescribed users of telmisartan are also intelligent enough to keep track of their blood pressure and get blood work done regularly.

A retrospective analysis of 50 studies suggests that telmisartan has a tolerability profile similar to placebo:

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#79

Not only telmisartan btw, all ARBs: “A difference between ACEis and ARBs is their tolerability profile, with ARBs having a rate of side effects similar to placebo.” (2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension)

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#80

Does a BP med’s half-life have a bearing on its effectiveness as a BP medication? For example, telmisartan’s 24 hours against losartan’s 4.

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