#41

FWIW: I like the combo of metoprolol and temisarton.

I take metoprolol in the morning and telmisartan in the evening.
Metoprolol seems to be prescribed by most doctors for old people with high blood pressure.

Metoprolol and telmisartan work differently to lower blood pressure:

Metoprolol is a beta-blocker medication.
It works by blocking the effects of epinephrine and norepinephrine (adrenaline and noradrenaline) on beta receptors in the heart and blood vessels.
This reduces heart rate, cardiac output, and blood pressure.

Telmisartan is an angiotensin II receptor blocker (ARB).
It blocks the binding of angiotensin II to angiotensin I receptors, which prevents blood vessel constriction and lowers blood pressure.
It also reduces aldosterone secretion, causing the kidneys to excrete more sodium and water, further lowering blood pressure.

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#42

I take labetalol, 50 mg, and telmisartan, 20 mg. Works very well for me.

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#43

Somehow my mother has reduced her BP from 150 to 130. The only things she’s added are GLYNAC and Taurine. She’s also been hitting the gym with my father. However I didn’t think either affected BP that much???

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#44
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#45

I’m just ecstatic for both my parents. I’m so proud of both of them for taking the right steps.

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#46

It’s probably the gym. I couldn’t believe that myself, until I tried to exercise every day which significantly dropped my blood pressure.

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#47

One thing ive noticed, since going ham on the telmisatan (80) and Jardiance (25) is some constipation. It seems to be taking the water out if you know what I am saying. Hopefully body gets used to the telmisartan, and it goes away as I’ve just started it

#48

Telmisartan shouldn’t impact this. But yes empagliflozin can, so make sure you drink enough water. And if needed reduce the empagliflozin dose to 10 mg.

#49

I’ve been taking telmisartan (first 20 mg, then increased to 40 mg), and empagiflozan (10mg) and am monitoring BP with Aktiia bracelet. I started at about 120/70, and my goal was to get closer to 115/65. I’ve been able to get to about avg 118/68. Not sure how much more I want to push things as far as adding more meds (e.g. amlodipine). It seems the higher the BP is the more impact these meds will have. Once you’re closer to optimal range, they don’t move the needle as much. Maybe I’ll try adding L-citrulline.

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#50

I take low dose beta blocker Propranolol occasionally. My BP is 106/66 and 40mg propranolol once daily decreases it about 6-8 points further with effect lasting more than 24h with gradual increase to my normal. Maybe it is sympathetic nervous system that drives your BP…

I also take L-citrulline, about 2,5g in my morning shake. It decreased my BP by few points too.

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#51

My blood pressure without b.p lowering meds was, at its worst, 147/101.
When I went back onto 10mg Telmisartan and 2.5mg Nebivolol my blood pressure drops to 99/69.

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#52

Just took my BP at a different hospital today. It was 116/69. This is great considering I had never been below 120/80 before and now I’m consistently in the 106-120 SBP range and 60-80 DBP. I’m giving Citrulline Malate the nod for this. Its great for optimizing BP for me.

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#53

I have the same issue. I started at around 133/79 mmHg (confirmed by home monitoring + Aktiia + traditional 24-hour automatic BP monitor). After 3 months of dapagliflozin, 4 weeks of Telmisartan 20 mg, and 2 weeks of Telmisartan 40 mg, I’m at about 126/75 mmHg. So -7/-4, pulse pressure (PP = SBP-DBP) went from 54 to 51 and MAP (DBP+PP/3) from 97 to 92. Getting better but far from ideal. According to the FDA, telmisartan 40 mg is supposed to reduce BP by “9 to 13/6 to 8 mmHg”. BP reduction takes a few weeks, so I assume after that, I’ll be around the lower end of that range (-9/-6 mmHg).

I assume that we’re both not super responsive to telmisartan. So, increasing the dose further will be useless. I’m also considering adding a long-acting dihydropyridine CCB (amlodipine 2.5 mg?) and/or a thiazide-like diuretic (indapamide 1.5 mg SR?).

I’m not super convinced by beta-blockers; in some studies, it’s associated with increased incidence of insulin resistance, dementia, and Parkinson’s disease. But there might be some reverse causation as propranolol is also given for tremors, and some people have tremors 10 to 20 years before their actual Parkinson’s diagnosis as an early symptom.

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#54

Interesting. Hopefully, the 40 mg telmisartan works for you, but likely won’t be enough to get all the way to <120/70. I think the best next steps are adding amlodipine @2.5 mg and potentially L-Citrulline. As you’ve pointed out, better to add meds at low doses than to keep going up on one. I just started 3 g L-Citrulline each morning today. It’s short half life of sth like 2-3 hours, and maybe slightly longer half life of efficacy through its effects on nitric oxide, makes me a little skeptical it will have a noticeable impact throughout the day, but its low risk profile makes it worth giving a try. Not practical to dose 3x/day, so will just go with 3g q morning for now. If this has no impact, I’ll likely try amlodipine 2.5g next.

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#55

Yes I think I’ll need telmisartan 40 mg + amlodipine 5 mg + indapamide 1.5 mg SR to reach my goals (24h average of [100-115]/[60-75] mmHg)…

I don’t know enough about L-citrulline but I’m skeptical:

  1. Short half-life: it’s proven that for a healthy ageing, BP variability matters as much if not more than average BP. To reduce BP variability, long-acting antihypertensive drugs seem most potent. Short-acting ones might have the opposite effects.
  2. Do we have large long-term data on L-citrulline use? Antihypertensive drugs are among the most used and the most studied drugs in the world. They’ve been around for a long time and they’re cheap. We know that most of them are very safe and might even prevent dementia. Do we have anything like this for L-citrulline? Is there any good reason to prefer L-citrulline to well-known antihypertensives?
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#56

Good points about L-citrulline. We certainly don’t have the same long-term clinical trial based data on efficacy and safety we have for the known classes of anti-hypertensive agents. I guess some of its appeal is that it’s over the counter/ no prescription needed. It has an appealing underlying mechanism of acting through nitric oxide and causing vascular smooth muscle relaxation. But agree, it does make most sense to exhaust the known and proven classes of antihypertensives. That said, I just bought a 200g tub of L-citrulline, so might as well give it a shot…

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#57

Have you looked into nebivolol? It’s quite different from the other beta blockers – all of the benefits, in fact w/extra benefits, and minimal downsides.

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#58

Risk of cancer with angiotensin-receptor blockers increases with increasing cumulative exposure: Meta-regression analysis of randomized trials

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#59

In reading tge above linked study its hard to understand their conclusionnwhen the author clearly makes this statement of findings from the largest collection of subjects and clinical trials

“the largest publicly available detailed data comes from the ARB Trialists Collaboration, which was a project dedicated to examine the risk of new cancers with ARBs. The sponsors of the randomized trials performed with these drugs provided the data to the ARB Trialists Collaboration [25]. This collaboration ultimately used comprehensive patient-level data, including a total of 138,769 patients from 15 randomized controlled trials [27–41] and concluded that there is no excess risk of new cancers with ARBs.”

The point was made to exclude those with already preexisiting cancers. Seems like a given assumltion but I guess past ones did not that showed increased risk?

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#60

Thanks, I’ll have a look!

For whatever reason, this low-quality paper is often posted on this forum. See: