Angiotensin II receptor blocker (ARB) experiences?

[Barnabas]

Thank you. I was thinking adding 5mg of Amlodipine along with increasing the Telmisartan might be the most effective. I think she has internalized many years of experiences with patients who are reluctant to take medication. She was skittish when I asked to switch from Losartan to Telmisartan (based on what I learned on this forum).

[DrFraser]

Most physicians are totally unaware of the unique features of telmisartan … I’ve heard from several people that their doctor’s have been pretty receptive to getting a copy of my write up and have been open to change. There are always the know it all types who don’t think any idea generated by anyone else has validity - but those doctors are dangerous and need to be avoided.
I’ve learned stacks, and changed my views on probably 50 things in the last 12 months … it should be that way as more data comes forward.
Hopefully you have a doctor willing to take a look at new information (or more realistically information that is newly presented to them).

[adssx]

Yes, the PPAR article convinced me!

For taurine: why 4 g? Why mid-day?

[DrFraser]

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10630957/

One of my colleagues - a Radiologist, actually feels 6 grams is the minimum based on this article. It has a T1/2 of just 1 hour I believe and getting a short cycling of mTOR daily just for hours. I didn’t dig into the details, but he does 6 grams, and seems to think he is getting the same benefits as taking Rapamycin from this.

My argument is that I’m not sure your body actually has time to change over to a starvation mode and change protein synthesis and have autophagy with just having an hour or two of mTOR inhibition.

I’m happier with having a couple of days each week of solid inhibition with Rapamycin, and then being in recovery, then tiny spurts of it with Taurine, generally separate from when I’m working out.

[adssx]

Yes based on this paper 1 g/kg/day for mice => about 6 g/day for a human. Bryan Johnson takes 3 g/day.

Yes, very short half-life, that’s why I was surprised that it reduced blood pressure over 24h (per ABPM) in one meta analysis!

[Davin8r]

@adssx

very short half-life, that’s why I was surprised that it reduced blood pressure over 24h (per ABPM) in one meta analysis!

Half-life in blood, but maybe accumulates in cells/tissues/organs?

[Tim]

@adssx

for gout risk, add an SGLT2 inhibitor

Yes, SGLT-2 could be the key if needed. I’ll first try adding the indapamide 1.5 mg SR, and if that results in a flare I could use empagliflozin or one of its cousins to lower uric acid. As a bonus, SGLT-2 is better than allipurinol for the kidneys.

I’ve been taking 2 g of taurine for about a year. Haven’t noticed that it does anything, like so many of the supps I take.

[adssx]

@Davin8r

Half-life in blood, but maybe accumulates in cells/tissues/organs?

I asked ChatGPT for potential explanations:

Despite this short half-life, taurine’s effects on blood pressure are more prolonged and can be explained through several mechanisms:

1. Antioxidant Properties: Taurine has antioxidant properties, which help in reducing oxidative stress. Reduced oxidative stress can improve endothelial function and promote vasodilation. The cumulative effect of reduced oxidative stress over time contributes to sustained blood pressure lowering.
2. Modulation of Sympathetic Nervous System: Taurine has been shown to modulate the sympathetic nervous system, reducing sympathetic outflow. A decrease in sympathetic activity leads to lower peripheral resistance and blood pressure. This modulation effect can persist beyond the immediate presence of taurine in the bloodstream.
3. Regulation of Calcium Homeostasis: Taurine influences intracellular calcium levels. By modulating calcium homeostasis, taurine can reduce the contractility of vascular smooth muscle cells, leading to vasodilation and, consequently, lower blood pressure. This effect can persist even after taurine levels in the blood have decreased.

@Tim

I’ll first try adding the indapamide 1.5 mg SR, and if that results in a flare I could use empagliflozin or one of its cousins to lower uric acid.

Let me know how it goes. You could also try indapamide 1.25 mg (normal release), or even split it to 0.625 mg. (You can’t split the 1.5 mg SR version, unfortunately.)

@Tim

I’ve been taking 2 g of taurine for about a year. Haven’t noticed that it does anything, like so many of the supps I take.

In any case, meta-analyses say it decreases SBP by only 4 mmHg, so it’s quite small, and you might not notice it. But everyone is different, and some drugs and supplements work more or less on each individual.

[Tim]

@adssx,

I think I’ll get a script for the 1.25 normal release, but use half to start. I am mindful of the three-month latency period. It took telmisartan two weeks plus to kick in. My BP is now 127 in the absence of caffeine. A little push from indapamide should bring it down to recommended levels.

After learning about berberine on this site, an unusually good source for educated opinions, I found out that, in addition to its renoprotective properties, it can reduce uric acid with no side-effects. I ordered the NOW brand, one of the most reliable brands, according to @约瑟夫_拉维尔.

Taurine didn’t give me the same boost in physical performance that I got from beta-alanine. There was a long thread on here about a year ago concerning the relative merits of taurine and B-alanine. Having tried both, singly and together, I am far more impressed by B-alanine, and it is not subjective. Researchers say you can expect a seven percent increase in performance. That’s a huge increase, for both sprinters and long-distance runners.

[adssx]

Does beta-alanine extend lifespan in some animals?

By the way, have you considered Coq10? It seems that 100 mg (the dose Bryan Johnson takes btw) can lower BP by about 10 mmHg: Coenzyme Q10 (CoQ10) U-shaped dose-response relation with blood glucose and blood pressure @DrFraser, what’s your opinion on CoQ10?

[DrFraser]

I think the issue with so many of the supplements that seem to be great is whether this is in isolation or in combination with other agents. It isn’t unreasonable to take this, and I personally take 200 mg each day.

In combination with other items - with Rapamycin being my only item that worsens lipids and glucose/insulin - CoQ10 might be helpful - but I think there are a multiplicity of items that I’d put ahead of it … such as an SGLT2-i.

[DeStrider]

COQ10 did nothing for my lipids. Bempedoic Acid and Ezetemibe did.

[adssx]

I agree. After my failure with indapamide I was looking for something else (as I’m already on dapagliflozin + telmisartan + amlodipine). But I should maybe add semaglutide first and then indapamide then…

@DeStrider

COQ10

Yes, it does nothing for lipids: Supplementation with coenzyme Q10 reduces plasma lipoprotein(a) concentrations but not other lipid indices: A systematic review and meta-analysis 2016

(even the Lip(a) reduction mentioned in the title is ridiculously small and non clinically significant)

[DrFraser]

I’d think you might look at Hawthorne extract as an addition to other meds. It works ress add lly well for some people, others not.

[adssx]

I checked Hawthorn but I couldn’t find good recent data on its safety and efficacy. The latest systematic review for hypertension is from 2020 and I can’t see the mmHg effect on SBP and SBP: https://www.sciencedirect.com/science/article/abs/pii/S2212958817301106 (does anyone have access?)

On the other hand CoQ10 is more studied and is considered safe. A 2021 review even found that it significantly reduced all-cause mortality in heart failure: https://www.heart.org/en/health-topics/heart-failure/treatment-options-for-heart-failure/complementary-and-alternative-medicines

[DrFraser]

Hawthorn has been pretty widely used … here is one review for consumers.
https://www.mountsinai.org/health-library/herb/hawthorn#:~:text=Side%20effects%20of%20Hawthorn%20are,when%20used%20in%20recommended%20dosages.

My Mom who pretty much was intolerant of most things, labile on anything she did tolerate … BP in 160’s up and down 140-200 mmHg on other things … monotherapy with hawthorn … BP 110-120 systolic - not labile … failed all the other stuff.

Anecdote … but also a fact.

[adssx]

Impressive!

The link you shared says:

Although hawthorn has not been studied specifically in people with high blood pressure, some people think its benefits in treating heart disease may carry over to treating high blood pressure (hypertension). However, there is not enough research to conclude whether hawthorn is effective at lowering blood pressure, and if so, by how much.

So I’d love to see more data. Unfortunately there are zero ongoing trials on Hawthorn. I could sponsor it to the MMC at least.

[DrFraser]

https://www.sciencedirect.com/science/article/abs/pii/S2212958817301106

Here is a pretty fair review - it either works or doesn’t - but seems safe. It’s worth a try for a lot of folks - be aware might take 6 weeks to see full effects.

[adssx]

Thanks. That’s the one I posted above, but four trials with a total 254 participants over a maximum of 16 weeks is not enough to convince me on safety Do you have the full paper by any chance? (I tried Hawthorn a few years ago, but probably over less than 6 weeks)

[DrFraser]

I don’t., but it has been a reasonable therapy recommended as part of my A4M training… with these recommendations going back now a decade.
But I may not have the safety details desired. It’s still a sensible option.
I like the natural options when available. Many of my patients are much more open to this than Rx drugs.