#144

SBP in 110s is optimal. So adding another med wouldn’t be safe. Pushing up Telmisartan to 160 mg could be safe as will only knock off a few mmHg. It certainly adds much better ppar activity. My precaution with this is pushing up doses of anything has risks. Generally making sure your basic metabolic panel on electrolytes and renal function remains good is needed. Just my general input … for conversation with your physician before you do anything.

4 Likes
#145

@ageless64 Do you track HRV? It can give insight into autonomic nervous system status. It’s not perfect (easily confounded) but it’s another window. Don’t try to game it. Just take a reading first thing every AM while sitting in a chair. Before caffeine.

2 Likes
#146

I’ve got a head-scratcher about COX-2 and telmisartan :thinking:

Here’s the deal:

  1. COX-2 is often bad news for prostate health. Higher levels typically = higher cancer risk.
  2. Telmisartan apparently boosts COX-2 levels.
  3. BUT some studies suggest telmisartan might actually help fight prostate cancer!

This contradiction is messing with my head. How can a drug that increases COX-2 potentially be good for prostate health?

Some questions I’m mulling over:

  • Is the COX-2 increase from telmisartan somehow different from other types of COX-2 elevation?
  • Could telmisartan’s other effects (like partially activating PPARγ) outweigh the COX-2 increase?
  • Are we missing something about how COX-2 interacts with prostate cells?

I know most studies so far are just in labs or mice, so we can’t jump to conclusions. But I’m really curious about this COX-2 puzzle.

Has anyone here looked into this before? Got any insights on COX-2’s role in prostate health that might explain this?

2 Likes
#147
  • [COX-2 is often bad news for prostate health ]

Just for you, I asked Dr. Oracle.

This is the query I used:

"COX-2 is often bad news for prostate health. Higher levels typically = higher cancer risk.

Telmisartan boosts COX-2 levels.

However, some studies suggest telmisartan might help fight prostate cancer."

Can you resolve this contradiction?

Telmisartan and COX-2

Paradoxical Effects

  • Telmisartan increases COX-2 levels, which seems contradictory to its potential anti-cancer effects

Potential Explanations

  • COX-2-independent mechanisms of action
  • Differential effects on various molecular pathways

Resolving the Contradiction

COX-2-Independent Anti-Cancer Effects

  • Telmisartan may act through pathways not directly related to COX-2
  • Possible mechanisms include:
    • Cell cycle regulation
    • Angiogenesis inhibition
    • Hypoxic modulation

Complexity of COX-2 Signaling

  • COX-2 effects may be context-dependent
  • The overall impact on cancer progression depends on the balance of multiple pathways

Potential for Dual Action

  • Telmisartan might simultaneously increase COX-2 levels and inhibit cancer progression through other mechanisms
  • The net effect could still be beneficial for prostate cancer management

Clinical Implications

Cautious Approach

  • Further research is needed to fully understand the interplay between telmisartan, COX-2, and prostate cancer

Potential for Combination Therapy

  • Telmisartan could be explored in combination with COX-2 inhibitors for synergistic effects

Personalized Medicine

  • The efficacy of telmisartan in prostate cancer may depend on individual patient characteristics and tumor profiles

Conclusion

The apparent contradiction between telmisartan’s COX-2-boosting effects and its potential anti-cancer properties highlights the complexity of cancer biology. While elevated COX-2 levels are generally associated with increased cancer risk, the overall impact of a drug like telmisartan depends on its effects across multiple pathways. The resolution lies in understanding that cancer progression is influenced by a complex interplay of molecular mechanisms, and interventions may have both pro- and anti-cancer effects simultaneously. Further research is needed to elucidate the precise mechanisms by which telmisartan may exert anti-cancer effects despite increasing COX-2 levels.

4 Likes
#148

:warning: Preprint :warning:
Association of the protective effect of telmisartan on hearing loss among patients with hypertension 2024

From the initial 860,103 patients with hypertension, a propensity score matched cohort was derived from 20,010 patients, with 2,193 in the telmisartan group. After PSM, lower incidence of total hearing loss was observed in the telmisartan group compared to the non-telmisartan group during the 3-year follow-up (0.5% vs. 1.5%, log-rank p=0.005). In subgroup analysis, this study showed consistent results that lower incidence of total hearing loss was higher in the telmisartan group than in the non-telmisartan group. Telmisartan was associated with reducing certain types of hearing loss in patients with hypertension. Further research is needed to confirm these findings and understand the mechanisms.

3 Likes
#149

I have a weird side effect of Telmisartan. In the middle of the night my left hand swells slightly yet noticeably but returns to normal in the morning. Has anyone else had this problem? I take Telmisartan at night. Maybe I should switch to morning.

#150

I raised my dose of Telmisartan from 40mg to 80mg and got a rather high potassium level of 5.1. I’m also on 5mg Nebivolol so I might be on too much. I backed down to 40mg Telmisartan.

1 Like
#151

Also take it at night (20 mg). Don’t have such side effect.

1 Like
#152

This is from Copilot:

Swelling in the hand that occurs at night and subsides by morning can have several potential causes:

  1. Fluid Retention: Lying down can cause fluid to accumulate in your hands, leading to swelling. This is often temporary and resolves once you start moving around⁵.
  2. Arthritis: Conditions like rheumatoid arthritis can cause swelling and stiffness in the hands, especially noticeable in the morning¹.
  3. Carpal Tunnel Syndrome: This condition can cause swelling, numbness, and tingling in the hands, often worsening at night⁴.
  4. Peripheral Edema: This is swelling caused by fluid accumulation in the tissues, which can be more pronounced at night³.

If the swelling persists or is accompanied by other symptoms like pain, numbness, or tingling, it might be a good idea to consult a healthcare professional for a thorough evaluation.

Is there anything specific you’re concerned about or any other symptoms you’ve noticed?

Source: Conversation with Copilot, 8/27/2024
(1) What are the causes of swollen hands? - Medical News Today. What are the causes of swollen hands?.
(2) Swollen Fingers: Causes and Treatment | The Hand Society. https://www.assh.org/handcare/condition/swollen-fingers.
(3) Swollen Hands in the Morning: Causes and Treatments - Healthline. Swollen Hands in the Morning: Causes and Treatments.
(4) Peripheral Edema: Definition, Causes, and Treatment - Healthline. Peripheral Edema: Definition, Causes, and Treatment.
(5) Hands or feet asleep? What to do - Harvard Health. Hands or feet asleep? What to do - Harvard Health.
(6) Edema - Symptoms and causes - Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/edema/symptoms-causes/syc-20366493.
(7) Finger swelling: Causes and their treatments - Medical News Today. swollen fingers in the morning - Search.

#153

I think you meant to quote @DeStrider but I actually get this sometimes too, but I figured it was from the 2iu of HGH I take before bed. Didn’t know Telmisartan could also cause this. I take both.

#154

@LaraPo Thanks. I know it’s not #2 or #3. So it must be fluid retention. It is a side effect of Telmisartan, so I shouldn’t be surprised. However, the symptom has gone away and doesn’t occur anymore.

My father has been getting swollen feet, so it must be something genetic regarding Telmisartan. For both of us it has been an initial side effect which has dissipated after a few weeks.

1 Like
#155

Telmisartan should actually slightly reduce water retention since it helps the kidneys remove excess water and salt.

3 Likes
#156

wow that is the telmisartan? I had to go in and pay 200 dollars for a prostate exam I think because I am too young for my insurance to cover it because I had some urinary retention for a couple days I was worried about lol

#157

African = Yes
White = No but why?
Asian?

Screenshot 2024-09-07 at 10.23.17 PM
Screenshot 2024-09-07 at 10.23.17 PM1204×302 68.7 KB
https://www.genengnews.com/topi

1 Like
#158

In most papers I read the protective effect is seen in all races (there are papers on this from all around the world).

5 Likes
#159

Indian paper, on rats, not great journal, sharing FYI: Evaluation of Anxiolytic Activity of Angiotensin Receptor Blockers Using Actophotometer Test in Wistar Rats 2024

Our investigation found that the telmisartan 5 mg/kg and losartan 5 mg/kg groups had considerable anxiolytic activity (p<0.05) compared to the control group, and it was comparable to the diazepam 2 mg/kg (p>0.05) group.
Conclusion: The findings of our study indicate that ARBs, specifically telmisartan 5 mg/kg and losartan 5 mg/kg, exhibit potential anxiolytic effects, evidenced by a significant reduction in locomotor activity in the actophotometer test. These results imply that ARBs could be considered as possible therapeutic agents for anxiety, providing a new perspective on their use beyond traditional cardiovascular applications.

2 Likes
#160

These mg/kg don’t map perfectly to humans do they? 400mg seems like a lot.

#161

Check the FDA guidelines for animal to human conversion factors (HED: Human Equivalent Dose).

#162

For rat divide by 6.2 so 64.5 mg for an 80kg human. That would put the 80mg dose of Telmisartan well into the anxiolytic zone for a human of ~175 pounds.

1 Like
#163

I was looking at the potential benefits of rilmenidine, assuming it will become available in the US at some point. My conclusion is that rilmenidine is not appropriate for those of us with low resting and sleeping heart rates even if that rate is due to lifelong distance running, as it is in my case. My mean sleeping heart rate over a measured run of three years (as measured by Apple watch but also manually and by an automated BP cuff occasionally) is 45 BPM but it can occasionally drop to 40 or even 39 briefly. I think this low rate rules out rilmenidine for me. For now, I’m staying with 40 mg. telmisartan which reduces my mid- to high normal BP to mid-to low normal levels. With less evidence, I also reason that whatever merit there is to the purported link between telmisartan and cancer is significantly reduced with the 40 mg. dose.

2 Likes