Ghoul
Member
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MESO-Rx
Anabolic Steroids
EU domestic source talk
- Thread starter Sampei
- Start date
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Is this potentially “better” than telmisartan + HCTZ?
They don't offer that service
Ghoul
Member
If you're using something higher than the minimum doses of Telm and HCTZ, yes. Evidence shows that very low doses of 2,3, or 4 different classes of BP meds are preferable to increasing the dose of combinations of fewer classes(or increasing the dose a single medication).
This is the current guidance from the major cardiology standards setting bodies in the US and EU, backed by a large body of clinical evidence.
Greater effectiveness, fewer sides.
In this case, an ARB, combined with a CCB, the preferred 2 class, has a diuretic added (assuming normal BP, now 120/70 or lower, isn't achieved with just the ARB and CCB).
Cilnidipine, a 4th gen CCB, superior to 3rd gen Amlodipine in every way, which already has lower incidence of Amlodipine's most common side effect, edema (about 10%), has that reduced even further by the diuretic.
Cilnipidine also appears to be as effective as Gabapentin at reliving neuropathic pain, is an effective treatment for Reynauds (painful toes or fingers when exposed to cold), and eases acid reflux symptoms as well.
Not brought to you by AI, but my own study of hypertension, lol
Last edited:
Awesome summary, thanks @Ghoul! So this is basically the last resort for BP control.If you're using something higher than the minimum doses of Telm and HCTZ, yes. Evidence shows that very low doses of 2,3, or 4 different classes of BP meds are preferable to increasing the dose of combinations of fewer classes(or increasing the dose a single medication).
This is the current guidance from the major cardiology standards setting bodies in the US and EU, backed by a large body of clinical evidence.
Greater effectiveness, fewer sides.
In this case, an ARB, combined with a CCB, the preferred 2 class, has a diuretic added (assuming normal BP, now 120/70 or lower, isn't achieved with just the ARB and CCB).
Cilnidipine, a 4th gen CCB, superior to 3rd gen Amlodipine in every way, which already has lower incidence of Amlodipine's most common side effect, edema (about 10%), has that reduced even further by the diuretic.
Cilnipidine also appears to be as effective as Gabapentin at reliving neuropathic pain, is an effective treatment for Reynauds (painful toes or fingers when exposed to cold), and eases acid reflux symptoms as well.
Not brought to you by AI, but my own study of hypertension, lol
Right now telmisartan 40mg seems to work for me, brings me down to around 120/75. Although peak practice prep a few weeks ago I needed 80mg for a few weeks. I blame the halo!
I was considering telmisartan + HCTZ because I like to eat a lot of potatoes, and I’m worried about hyperkalemia if just using telmisartan by itself.
Ghoul
Member
40 is the starting adult dose, so yeah, if that's working. best practice would leave you there.
But if you needed more to stay below 129 (which is where you should be) year round, rather than upping the Telm, a low dose CCB wound be considered preferable to Telm 80, like Telm 40/Amlodipine 5, easily available as a single pill combo. It reduces the chance of Telm induced sides, and very unlikely to induce new ones at that small dose of Amlodipine. Also, part of the concept is that by relaxing blood vessels using multiple mechanisms, you benefit from more protection, as each class affects areas of circulation others don't.
I would just like to add that Indapamide ( thanks for the recommendation @Sampei ) is an overall much better diuretic than HCTZ with more additive benifits beyond hypertension control. It also has a longer half life, even more so with the sr version, and will give you better 24hr control with once daily dosing.
Thanks guys! I have some reading to do this coming week.
Looks like telmisartan, amlodipine and indapamide are the new triple combination being investigated. Novel low-dose triple single-pill combination shows efficacy and tolerability in two international trials
EDIT: Ghoul beat me to it.
Looks like telmisartan, amlodipine and indapamide are the new triple combination being investigated. Novel low-dose triple single-pill combination shows efficacy and tolerability in two international trials
EDIT: Ghoul beat me to it.
We all trying our best to educate eachother on the best way to take care of ourselves. you are welcome my man
Ghoul
Member
Not to hijaak this thread, but as this is relatively new info and potentially lifesaving, I'll just make this one final post on the topic,
The TLDR is systolic over 130 should be treated with medication to bring down at least into the 120-129 range. This doesn't apply to everyone, but any anabolic steroid use is a "risk modifier" that puts you into the 10 year elevated risk category for cardiovascular disease.
This became the US standard in 2023 and was adopted in the EU Dec 2024. Assuming EU primary care doctors are like those in the US, many seem unaware of this change and don't intervene until 140 or 150.
The TLDR is systolic over 130 should be treated with medication to bring down at least into the 120-129 range. This doesn't apply to everyone, but any anabolic steroid use is a "risk modifier" that puts you into the 10 year elevated risk category for cardiovascular disease.
This became the US standard in 2023 and was adopted in the EU Dec 2024. Assuming EU primary care doctors are like those in the US, many seem unaware of this change and don't intervene until 140 or 150.
MaxROM
New Member
Source for isotretoin/accutane ?
Dokteronline or BG or pctzone
Photon
Member
If you're using something higher than the minimum doses of Telm and HCTZ, yes. Evidence shows that very low doses of 2,3, or 4 different classes of BP meds are preferable to increasing the dose of combinations of fewer classes(or increasing the dose a single medication).
This is the current guidance from the major cardiology standards setting bodies in the US and EU, backed by a large body of clinical evidence.
Greater effectiveness, fewer sides.
In this case, an ARB, combined with a CCB, the preferred 2 class, has a diuretic added (assuming normal BP, now 120/70 or lower, isn't achieved with just the ARB and CCB).
Cilnidipine, a 4th gen CCB, superior to 3rd gen Amlodipine in every way, which already has lower incidence of Amlodipine's most common side effect, edema (about 10%), has that reduced even further by the diuretic.
Cilnipidine also appears to be as effective as Gabapentin at reliving neuropathic pain, is an effective treatment for Reynauds (painful toes or fingers when exposed to cold), and eases acid reflux symptoms as well.
Not brought to you by AI, but my own study of hypertension, lol
I personally dislike triple combo pills.
They are great for compliance but not the best in terms of dosage timing. It usually includes a diuretic which is probably not good to take at night.
I prefer double combo pills.
Something like 2 double combo pills.
Azilsartan medoxomil + Cilnidipine or Telm + Cilnidipine at night, personal preference.
Nebivolol + indapamide (diuretic) in the morning.
That being said, I usually avoid diuretics in general.
Ghoul
Member
Beta blockers are the last choice in the protocols, unless there's a specific indication for them, because while they lower BP, they push the incidence of negative outcomes back up, fyi,
Photon
Member
I know.
I take Nebi for high RHR.
reader
New Member
My favorite sources are gone or not in a good state anymore. It seems many are out of stock with primo/mast as well (optiEU for example). I used BP/SP and Pharmaqo previously. Im thinking of Driada as last resort, any other recommendations?
Except nebivolol for all the studies I have read.
Why Nebi in the morning? And not in the night with telmisartan?
I wish I had access to clinidipine damn it
malomkarom
Member
The entire EU market only has 10mg tabs, it's hideous.
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