#221

I believe there’s a period of adjustment. You could go super slow, gradually escalating over weeks to 50, 60, 70, 80 (obv. tricky splitting pills!) and your body will adjust. Of course you might have huge BP variation throughout the day, but it’s less likely with telmisartan, as it’s supposed to get your BP to be less variable.

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#222

5 months.

I agree splitting them in half-ish seems easy but smaller quarters would be a challenge.

But I suspect the consensus would be making the daily dose the same (e.g., 60mg) rather than alternating between 40mg and 80mg EOD.

#223

In my observation there is a behavioral component associated to ARBs, at least with telmisartan. This facet can continue to favorably modulate the variance in BP over a much longer period than is required for the biochemical stabilization. If you can tolerate it, there are well researched ASCVD and renal benefits associated to the 80 mg. dose. Telmisartan reduces the rate of decline in kidney function by as much as 49%. Likely less in younger people with normal kidney function but still geroprotective.

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#224

Olmesartan superior to telmisartan in certain contexts? Olmesartan 40mg lowered inflammatory markers such as hsCRP and IL-6 while telmisartan 80mg did not, and lowered SBP/DBP more than telmisartan - old Japanese paper, small number of subjects:

Comparison of Effects of Olmesartan and Telmisartan on Blood Pressure and Metabolic Parameters in Japanese Early-Stage Type-2 Diabetics with Hypertension

https://www.nature.com/articles/hr2008303

This was confirmed in lower dosages olmesartan 20mg and telmisartan 40mg:

Comparison of Effects of Olmesartan and Telmisartan on Blood Pressure and Metabolic Parameters in Japanese Early-Stage Type-2 Diabetics with Hypertension

https://www.nature.com/articles/hr2008303

And again, this time also showing lower albuminuria in olmesartan users:

Difference in the effects of switching from Candesartan to Olmesartan or Telmisartan to Olmesartan in hypertensive patients with type 2 diabetes: the COTO study

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#225

Good find. What is the half life of Olmesartan and are there any downsides?

#226

Roughly half, a little over half of telmisartan, about 13 hours (10-18). But once you’ve adjusted to it, it can typically be taken once daily and be effective for 24 hours. Telmisartan is likely safer, because olmesartan can in rare cases cause severe diarrhea. Telmisartan is a more straightforward and more predictable drug, while olmesartan has a more complicated mode of action. The pleiotropic effects (i.e. apart from BP impact) is different, with telmi more effective for CV and lipid issues.

All in all, it depends on your particular needs. For me, telmi is better, as I don’t need stronger BP control or help with inflammation. But for others olme might be a more interesting choice. It’s good to be aware of options, which is why I posted this.

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#227

Olmesartan doesn’t cross BBB so you lose that benefit of Telmi. I personally prefer Telmi.

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