Telmisartan -- 40 or 80 mg

[AnUser]

BMI - fake.
HbA1C - fake.
LDL cholesterol - fake.
Dietary sodium intake - fake.
BP - fake.

The U-shape bottoms at being overweight, diabetic, with high LDL cholesterol and BP. All because of residual confounding. Of course too low is of course bad for many of these, just that the optimal range is way off.

Gil Carvalho did a video on this too.

[DrFraser]

I love the way you challenge conventional thought. I don’t even think you believe the things you just wrote, but it is more of challenge to individuals to think around the data.

So yes, you can claim confounding due to poor lifestyle, but ultimately, as a physician, these markers end up having an indicative part of my assessment of risk of premature death or disability.

Are there individuals with a BMI of 30 that are metabolically healthy? Absolutely, but are there folks with a a BMI of 50 who are ---- not a single one of them.

Same thing with the other measures - there is outcome data, and as much as there are confounders, as a human being, I’d much rather have my BMI at 23 than 50, my HbA1C at 4.7 than 10, my ApoB at 70, my sodium intake <1500 mg/day, and my SBP <120 mmHg. All of those items predict a better health and lifespan.

Now as to whether having good numbers is the direct cause of the mortality benefit - I don’t think it hugely matters - the actions required to get good numbers are important and the numbers are just an indication of those actions.

Very scared to start a challenge like this with you – I’ll likely bow out early!

[AnUser]

I think you misunderstood my point.

The “good” numbers “discovered” in these studies, is actually in the true suboptimal range if they weren’t flawed with residual confounding, that’s my point. The lowest ACM is being diabetic. Same is being overweight. Or have high LDL cholesterol. That’s what the studies say.

That’s why the U-shape curves are fake, because they clearly are and because of other evidence showing it’s residual confounding placing where the bottom of the curve is.

[DrFraser]

Brilliant, we agree … so glad about this as you are way too smart to debate.

[RobTuck]

I think predictive and perhaps other forms of validity are being confused with the shape of a curve which was my original question. This becomes obvious when a (theoretically) “true” value is referenced.

[AnUser]

It’s not going to be at the level where you’re not falling from dizziness.
I think optimal seems to be as low as you can go without that happening, with care if you’re older to be extra careful not to increase your risk for falls. Yanomami have quite low BP throughout their life, but it’s ecological data.

See this thread also:

Pressão arterial ideal que devemos atingir? Sistólica abaixo de 110 ou 100?

‘Normal’ blood pressure is no longer a safe haven: take shelter under ‘optimal’ blood pressure Several population-based studies have demonstrated that SBP levels currently considered normal (<130 mmHg) are not safe, and in fact, there is a graded increase in CVD risk as SBP increases beyond 90 mmHg.4–7 Whelton et al .6 found that the amount of coronary artery calcium and the risk of incident atherosclerotic CVD increase with increasing SBP levels, even in individuals with SBP 90–120 mmHg. In fact, mounting evidence has made it abundantly clear that so-called high normal BP levels (120–129 mmHg) are associated with a significant increase in incident CVD compared with SBP levels of 90–100 mmHg. This connection may be much more pronounced in yet to be identified subgroups. This means that CVD risk starts even when SBP is a long way below 130/80 mmHg, which is the current threshold used to diagnose and define hypertension.8 Therefore, the guideline-based definition of normal BP does not …

[DrFraser]

For this example, avoiding trauma as one gets older is critical, so a risk/benefit has to be part of the equation. It doesn’t help you to have a SBP of 90 and take a fall fracturing your hip at age 80 where you have a 50% mortality as a result in the next 12 months. The benefit in lowering BP as folks get in the 70’s+ also diminishes. Not to say we shouldn’t treat systolics of 200, but I’m not sure we have good evidence for pushing this down into the 110’s.
I tend to look at avoiding adverse outcomes in my practice, and as such, there is a need for a balanced approach. Perfection can be the enemy of good.

[zebit0]

Thanks for that info! I continued researching this with Claude (so possible AI error grains of salt), and this was the summary:

Here’s a summary of the blood pressure reduction effects of Telmisartan and/or Amlodipine:

Telmisartan 40mg typically reduces BP by 19.8 / 8.8 mmHg.
Telmisartan 80mg may provide an additional 2-4 / 1-2 mmHg reduction.

Amlodipine 5mg usually lowers BP by 15-25 / 10-15 mmHg.
Amlodipine 10mg may offer an extra 2-5 / 1-3 mmHg reduction.

Combinations:
Telmisartan 40mg + Amlodipine 5mg: ~23.7 / 10.3 mmHg reduction
Telmisartan 80mg + Amlodipine 5mg: potentially 25-28 / 11-13 mmHg reduction
Telmisartan 40mg + Amlodipine 10mg: possibly 26-30 / 12-15 mmHg reduction

These figures are averages. Combination therapy generally provides greater BP reduction than monotherapy, with the Telmisartan/Amlodipine combination showing particularly good efficacy and tolerability.​​​​​​​​​​​​​

In the studies I reviewed the most common dosage was Telmisartan 40mg + Amlodipine 5mg in bold above.

In my case (I provided some additional details) it estimates a reduction from:
138/88 unmediated
to
122/78 which is nearly ideal. I’m waiting for my Amlodipine to arrive and will add it then report back in about 4-5 weeks.

Studies referenced (and I’d appreciate any relevant additional or more recent studies):

1. The main study we analyzed in detail: “Clinical data analysis of telmisartan for hypertension management in Indian population” (Bioinformation 17(6): 652-659 (2021))
2. TEAMSTA-5 Study (2011): Published in the Journal of Clinical Hypertension
3. EXCEL Study (2012): An 8-week randomized controlled trial
4. Meta-analysis by Xu et al. (2014)
5. PIANIST Study (2014): A large-scale observational study
6. Barrios et al. Study (2015): A pooled analysis of data from multiple studies
7. Goyal J et al. study (2014): Published in the Journal of Clinical and Diagnostic Research

[tj_long]

@SilentWatcher

I am taking 80mg on my cardio days and days after cardio, as telmisartan increasing adiponectin expression, stimulating AMPK (besides effect on PPAR gamma, mentioned above) - no side effects, except better skin appearance and better AMPK activation

Still going with 40mg on the days with weightlifting and resting days afterwards.

Before or after cardio? According to Wikipedia:

“Telmisartan’s activity at the peroxisome proliferator-activated receptor delta (PPAR-δ) receptor has prompted speculation around its potential as a sport doping agent as an alternative to GW 501516.”

[RobTuck]

Are you splitting the 80 mg days AM and PM?

[stealle]

@adssx

I’ve been taking Telmisartan for about 6 weeks. Started at 40mg. Moved up to 80mg after 2-3 weeks. My reduction in BP has been fairly negligible. Maybe reduced it by 10 systolic and 5 diastolic. I’ve considered adding amlodipine 5mg but I’m concerned about ankle edema being a very common side effect of amlodipine. I have a little ankle edema now. Although, I read a study that says most of the ankle edema caused by amlodipine monotherapy is mitigated by adding Telmisartan: Effect of telmisartan addition to amlodipine on ankle edema development in treating hypertensive patients - PubMed Have any of you taking amlodipine noticed ankle edema?

Also, I started taking a supplement called “Carditone”. Seems to have dropped my systolic another 15mm/hg taking 1 per evening after just two days. Not sure if this will be transient. Too early to tell. Was wondering if anyone could share their thoughts on this supplement.

[adssx]

@stealle

My reduction in BP has been fairly negligible. Maybe reduced it by 10 systolic and 5 diastolic.

That’s not negligible!

@stealle

I’ve considered adding amlodipine 5mg but I’m concerned about ankle edema being a very common side effect of amlodipine. I have a little ankle edema now. Although, I read a study that says most of the ankle edema caused by amlodipine monotherapy is mitigated by adding Telmisartan

Yes telmisartan 80 mg + amlodipine 2.5 mg or 5 mg has a very low rate of edema. But it’s still a risk. So if you already have an edema you might not want to take that risk. Or you can give a try to 2.5 mg and see?

In European and American guidelines they recommend a thiazide for people you don’t want a DHP CCB. Something like indapamide 1.5 mg SR. It takes 3 months to see indapamide’s full BP lowering effect. It can increase glucose in some people.

Alternatively you could try lercanidipine. Same family as amlodipine but I think it does not cause edema. But I don’t know if it’s as good as amlodipine overall.

[LukeMV]

Carditone (Reserpine) fell out of favor due to the side effects of depression and GI issues

Blood pressure‐lowering efficacy of reserpine for primary hypertension

I think I heard somewhere it acts on neurotransmitters but don’t quote me.

I do find it interesting it’s available as an OTC supplement now.

[Ziegelhausen]

I take 120mg telmisartan and 2.5 mg amlodipine. This combination got me from 120s systolic to 115-119. No ankle edema on that combo.
If I take 5 mg of amlodipine I get ankle edema, even with 120 mg of telmisartan.

[jnorm]

@tj_long

Before or after cardio? According to Wikipedia:

“Telmisartan’s activity at the peroxisome proliferator-activated receptor delta (PPAR-δ) receptor has prompted speculation around its potential as a sport doping agent as an alternative to GW 501516.”

I’ve looked up subjective reports on this, and the consensus seems to be that athletic perfomance is negligibly impacted, at least at the commonly used doses.

Too bad, because if there was a cardarine without cancer links and even potentially pro-longevity, that would be an incredible molecule.

[tj_long]

I tested it before a workout, and it clearly reduced my performance. Telmisartan didn’t suit me in other ways either, so I stopped using it.

[LukeMV]

How are your serum potassium levels on that amount?

[Ziegelhausen]

Funny you should ask. Potassium came back a little high at 5.4 recently. But in August it was 4.3, and I’m pretty sure I was already at telmisartan 120 at that time. I will recheck in March.

[LukeMV]

Hmm. I would re-test it to confirm. 5.4 is a bit higher than I would be comfortable with I think.

@DrFraser would you say a Potassium level of 5.4 is high enough to reduce the dose?

[DrFraser]

I’d tend to get it redrawn as handling of the specimen is critical with potassium levels. If indeed it remains at 5.4, that is not ideal. Having higher range potassium seems healthier until your get over the upper reference level (some labs 5.0, others up to 5.4). Interestingly we see an increased rate of cardiac events in individuals with potassium levels that are elevated - especially if on diuretics. However, it probably matters on what the cause is (e.g. bad kidneys = bad blood vessels = high potassium).