I’m 38M, 6’2", 192 lbs, in decent shape (muscular, but could lose a few pounds), and have had borderline high blood pressure at least since I was 20. My diastolic is good, but my systolic fluctuates from 120-135. My pulse pressure (systolic - dyastolic) is unfortunately high. My doctors generally refused to prescribe a BP med because I look healthy and my BP isn’t that high. But I’m aware that anything above 110 isn’t healthy and likely cutting years from my life. And a high pulse pressure is bad as well.
What are the best BP meds to try, according to longevity research (and your experiences)? What should I try first?
I’m starting out on Telmisartan + Amlodipine, but wondering if there’s better options. Thanks!
I would try out the telmisartan first and if you are not happy with the result, I would add
metoprolol. Metoprolol and telmisartan are first line medications prescribed by cardiologists. I am taking both, metoprolol in the morning and telmisartan in the evening.
I am quite happy with the result. Unless you are quite muscular I would suggest shedding some pounds down to ~182 which would be the optimal BMI suggested by many calculators.
Why not start out with telmisartan first, and see what it does for you, before adding amlodipine? Telmisartan is long lasting, and has a good safety profile. I’d start with 40mg and go to 80mg if needed. That should be enough, takes you down roughly 15-20 points on SBP, and you donn’t have much room on DBP, so the 5-8 points down on DBP is safer. I’d only think about adding amlodipine if you don’t respond to telmi, and then start with 2.5mg to avoid edema.
But desertshores is 100% right, drop extra lbs first. It makes a huge difference. You may not need drugs at all, especially if you exercise and don’t overdo salt intake.
Another vote for telmisartan. It looks to be a twofer in terms of long term benefits. I also agree with daily EVOO, at least one tablespoon up to three. Other nutritional substances can make smaller contributions in many cases.
Because taking both at the same time would drop my blood pressure too much. Taking one in the morning and one in the evening produces a more even 24 blood pressure result.
Do you have any experience with telmisartan 40/40 @desertshores? A dose of 40 manages my BP to a decent level and the data says that 80 doesn’t do much more for BP but is beneficial for longevity effects. I thought I might give a divided dose of 80 a try.
Unlike many of my meds, telmisartan and metoprolol were not self-prescribed.
My cardiologist prescribed metoprolol and my primary physician prescribed telmisartan to get my BP to a more ideal level.
Good idea. I tried Telmisartan a while back with ok results, but I thought it caused me to feel tired. I’m trying it again. Using both meds at the same time to try and undershoot the desired blood pressure. If my pressure gets too low (yay!) I’ll look into removing one or decreasing the dosage. My previous experience indicates that Telmisartan 80mg by itself isn’t enough to get below 110.
Also working on losing weight as suggested by others.
I take Amlodipine(calcium channel blocker) + Linsopril(angiotensin-converting enzyme) works great for me. I do have to adjust dosage down when my weight falls periodically. I take both at bedtime and take blood pressure in morning. Everyone is different so I would suggest this combo if unsuccessful with current regime. Good Luck
If you enjoy exercising, beta-blockers (metoprolol) are not the primary option. I would personally try just telmisartan at first, up to 80 mg if necessary. It’s important to note that the full effect of telmisartan comes with a delay, so it’s worth waiting patiently for 3–4 weeks (and check your potassium level) before considering additional medications.
Just FYI, I took telmisartan for a couple of weeks and it made me feel emotionally terrible. As it turns out that’s one of the side effects. Despair. I’ve never seen that described in a side effect of a drug. I couldn’t figure out what was going on and then I looked up the side effects. It’s kind of funny actually. As soon as I stopped it it cleared up within a day or two. But it was dramatic. So just be careful.
That’s very interesting, thank you! What’s really strange is that it’s ever so slightly counterintuitive, because telmisartan increases (spares) lithium. Which you’d think would have the opposite effect than despair, and indeed, some telmisartan users report a dramatic improvement in mood. Just goes to show, it’s very hard to anticipate how a drug is going to affect you, it’s all very individual.
Just one more data point here - recently switched to telmisartan from losartan (12+ years of that) and my sys/dia is down ~5-10 points, pretty regularly 110-120/70-80. 54yo male, 180lbs, family hypertension history. Fortunately no new side effects (I think?!).
I’m also in a long-haul fight with Parkinson’s so this is one more arrow in that quiver.
I also have a similar BP, of about 135/70, and have been putting off medication for a long time. My BMI
is good. I’ve been considering Telmisartan but am curious about Rilmenidine. Can anyone here
compare the two?
There are a lot of different medications that can lower BP, but telmisartan is preferred by many in this community because it’s been shown to have effects on longevity that seem to be independent of its blood pressure lowering effects. See Why Telmisartan Is Best For Blood Pressure - Life Extension
It’s always a good idea to try to figure out why a person has elevated blood pressure. Sometimes it’s idiopathic (aka essential) and we don’t really know. But it could be something like sympathetic tone issues which can be addressed with Vegus nerve stimulators and whatnot. Could also be heavy metal such as lead. Vascular inflammation is another potential area to look at. Imbalance between calcium and magnesium.
Of the drugs out there, the ace inhibitors and arbs seem to have the best evidence for secondary benefits. ARBs seem even better than Ace inhibitors. And from my research into the drugs, telmisartan seems to inch out the other ARBs - which makes it my drug of choice.
You might want to also consider daily tadalafil (2.5 or 5mg). More and more studies seem to indicate that it’s a potent longevity truck