Telmisartan -- 40 or 80 mg

Interesting article by Saavedra, but perhaps too optimistic about ARBs than than the evidence suggests. Summarizer: “This is a useful compendium of the pleiotropic pharmacology of ARBs, and the core idea — that RAS dysregulation contributes to diverse pathology — is well-supported. But the leap from “ARBs do interesting things in cell cultures and rodents” to “ARBs should be used for Alzheimer’s, depression, and menopause” needs much more clinical trial evidence than currently exists. The review is better as a research roadmap than as clinical guidance.​​​​​​​​​​​​​​​​“

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Now you know that isn’t a fair statement - that olmesartan outperformed the other meds. At least based on what you quoted.

They weren’t compared to each other and the confidence intervals are overlapping - and not by just a little bit.

I do seem to remember there was one situation where olmesartan did outperform talmisartan but not in the data you quoted.

Look at table S4 “Adjusted Hazard Ratios for Dementia Risk Across Individual ARBs”. So this is within class of ARBs. Irbesartan was the reference (based on neutrality in previous studies), and olmesartan stood out for significance (p value >0.001). Within ARBs using Irb as reference (AHR 1.00) Olme was 0.55 Telmi 0.94 (NS). And the CI on Olme was 0.43-0.71, whereas Telmi was completely outside the Olme range 0.84-1.05.

For ACM see table S9 and the within class (ARBs) numbers - again Olme was the lowest 0.64 vs Telmi 0.91. And the CI were non overlapping with Olme 0.56-0.74 and Telmi 0.85-0.97.

Keeping in mind we are dealing with decent size cohorts, not a handful of subjects.

After all this time, 40 or 80 for longevity? :slight_smile:

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I don’t know that the thresholds are well understood for broader benefits. Taking 80 mg/day, the mean reduction in systolic blood pressure is approximately 12–13 mmHg and diastolic blood pressure is ~ 7–8 mmHg. For many, the limiting factor will be their baseline BP. A person with high normal BP can likely take a full 80 mg dose and still have adequate, perhaps optimal BP. That is my situation. A person with mid-normal or lower baseline BP will have to see if they can maintain adequate BP with 40 mg or 20 mg. Many normotensive people are reporting doing well and actually improving their BP profile taking either 20 or 40 mg/day. I do very well, with no dizziness or other symptoms with a mean BP of 104/62. Empirical. No hard formula and your minimums may vary.