#121

The compliance might be higher but the safety and efficacy is lower, it’s like people preferring berberine over statins, or ezetimibe even though the latter has an 18,000 people trial.

So they are irrational technically.

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#122

@AnUser You are absolutely correct … but as a clinician I have to meet people where they are at. I have patients who regularly reject almost every conventional evidence based approach - but will accept other items - yes irrationally - but my goal isn’t to win an argument based on evidence - it is instead to improve their health outcomes.
The good news with something like a blood pressure medicine/supplement, is the result is easy to measure and assess. On the safety side, I don’t see reason for concern beyond the usual stuff with supplements.

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#123
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#124

I’m confused. Are you saying 80mg Telmisartan will have a less potent effect on blood pressure reduction than a lower dose, despite having a more positive effect on insulin sensitivity and dementia prevention?

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#125

No I’m saying going from 20 mg to 80 mg will not make a difference, I’m saying the incremental benefit going from 0 mg to 20 mg will generally be bigger than going from 20 mg to 80mg.
Most BP meds have the majority of impact at low dose.

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#126

That makes a lot more sense! Well I’ve been on 40mg for years but I’m now convinced I should be on 80mg thanks to this thread and the article on your web site, so I’ll be raising my dose tonight. Thanks for bringing awareness to this

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#127

I tried berberine with great expectations. Unfortunately, as some papers say, one of the potential sides is gastrointestinal distress.

#128

After adding 20 mg of Telmisartan, my father’s SBP has dropped from 120-130 to the 100-110 range. This is optimal IMHO and a good testament to Telmisartan!

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#129

Adding it to what? Does he have a BP stack?

#130

Actually, that’s his only BP medicine. He’s a vegan gym rat and really quite healthy for a 77 yo. We’re just working on his blood biomarkers to get them into an optimal range. BP was a little too high for our liking so we added 20 mg Telmisartan.

First step was LDL and Apob going from 130 and 120 to 65 for each with Bempedoic Acid + Ezetemibe.

Metformin (500 mg daily) to keep him out of pre-diabetes (HBA1C 5.5).

Jardiance (SGLT2i) 12.5 mg to protect his kidneys, heart, and mind.

Rapamycin (3 mg + GFJ weekly) to help him live longer.

Those are his meds for preventative healthcare. All his biomarkers are in optimal ranges now. He just had his CAC scan on Father’s Day. :slight_smile:

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#131

That’s annoying he is that good on his BP. I really love it when people have enough BP to at least get them to 80 mg of telmisartan. It’s a different perspective … I’m frustrated when I hear a new patient tell me their BP is 110 systolic … that rules out an Rx for Telmisartan. I’m glad Dad’s BP is not optimal … make sure not to push it too hard as risk of falls/orthostatic changes go up with age. Some deliberate care with change from lying to standing is needed as these medications do block the rapid reaction to improve cerebral perfusion with standing … and literally, taking a full 60 seconds on change from lying to sitting to standing is needed especially in aged individuals to avoid excess rate of falls/syncope.

Sounds like Dad is optimized. Can probably let his life insurance lapse as you’ll not be seeing that policy activated any time soon!

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#132

Telmisartan is considered a weak ARB by some doctors.

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#133

Telmisartan is much better than Losartan which is what most patients in Hong Kong and the USA get as a first treatment.

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#134

It’s been reported here that the ARBs have a flat dose/response curve, which limits their effectiveness. I take telmisartan 40 and no more than 5 mg of amlodipine, to avoid pedema. With this combination, I still have Stage 1 hypertension. I’m concerned that adding a diuretic would increase uric acid and bring on a case of gout. I’m thinking of going back to lisinopril, whose effectiveness does increase with dose. If I tried 20 mg of lisionpril with 5 mg of amlodipine, I bet I’d get a good response. Lisinopril does tend to induce a nagging cough, but it’s not like a Covid cough. i wouldn’t be hacking my guts out.

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#135

image

Same flat response for lisinopril? https://www.researchgate.net/publication/232612007_Fast_Parameters_Estimation_in_Medication_Efficacy_Assessment_Model_for_Heart_Failure_Treatment/figures?lo=1&utm_source=google&utm_medium=organic

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#136

@Jonas: has any of these doctors provided you with any source?

All sources I found concluded that telmisartan offers better BP control than losartan (the default ARB in most of the world except India where telmisartan is the default). It makes sense as it has a way longer half life (it’s the longest acting ARB). In addition it improves insulin sensitivity. See: Metabolic effect of telmisartan and losartan in hypertensive patients with metabolic syndrome | Cardiovascular Diabetology | Full Text

And telmisartan users have a 30% lower rate of Alzheimer’s and Parkinson’s compared to other ARB users in longitudinal studies. There are ongoing RCTs to confirm whether the relationship is causal or not.

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#137

Elanapril could be more effective than lisinopirl.

#138

But you might have a 2x rate of Alzheimer’s and Parkinson’s compared to telmisartan :man_shrugging:

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#139

That’s awesome. Is he on any hormones like TRT, thyroid, etc?

#140

No hormones or TRT. I’m just happy he agrees to preventative medications instead of waiting for the onset of disease.

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