Blood Pressure

[BamaCrazy]

Apparently it is not approved because the manufacturer doesn't want to spend the insane amount of money required to get FDA approval. They have over 100 studies. However, they literally want 1000's, and of course the full FDA trial process.

PCT can get Azilsartan. After reading your above comments about it and reading a comparison study between Azilsartan and Telmisartan, I emailed PCT 24x7. Pretty expensive. A month of 40mg is about $14. But beats the US price a lot when not covered by insurance. I can get 12 month of 80mg from India for $288. The US price is $1,596.

40 mg x 10 tablets - 4.5$
80 mg x 10 tablets - 8$

 

[BP_6]

PCT can get Azilsartan. After reading your above comments about it and reading a comparison study between Azilsartan and Telmisartan, I emailed PCT 24x7. Pretty expensive. A month of 40mg is about $14. But beats the US price a lot when not covered by insurance. I can get 12 month of 80mg from India for $288. The US price is $1,596.

40 mg x 10 tablets - 4.5$
80 mg x 10 tablets - 8$

Yea, I emailed him and got some a while back. The brand he sent me is actually the exact same company that was announced that was FDA approved to make the generic version in the USA recently. Bright yellow tablets that are legit. I know that not only from measuring my bp, but they have a very odd, distinct smell to them. Didn't think anything of it until I came along somewhere online that azilsartan has a unique smell.

While not by a huge margin, it is the strongest overall speaking in terms of pure blood pressure lowering effects of any ARB on the current market.

What will be interesting to see in the future when it becomes more available as it is brand new. In fact the first new type of BP med to come along in many years. Designed for people that don't respond well to current BP meds is Tryvio (aprocitentan) It is an endothelin receptor antagonist. So it works through a completely different mechanism than ARB's.

 

[BamaCrazy]

Yea, I emailed him and got some a while back. The brand he sent me is actually the exact same company that was announced that was FDA approved to make the generic version in the USA recently. Bright yellow tablets that are legit. I know that not only from measuring my bp, but they have a very odd, distinct smell to them. Didn't think anything of it until I came along somewhere online that azilsartan has a unique smell.

While not by a huge margin, it is the strongest overall speaking in terms of pure blood pressure lowering effects of any ARB on the current market.

What will be interesting to see in the future when it becomes more available as it is brand new. In fact the first new type of BP med to come along in many years. Designed for people that don't respond well to current BP meds is Tryvio (aprocitentan) It is an endothelin receptor antagonist. So it works through a completely different mechanism than ARB's.

I found another source selling the 80mg strips for $1.70. That’s likely impossible to beat. $61 for 12 months.

 

[BazzBeat]

PCT can get Azilsartan. After reading your above comments about it and reading a comparison study between Azilsartan and Telmisartan, I emailed PCT 24x7. Pretty expensive. A month of 40mg is about $14. But beats the US price a lot when not covered by insurance. I can get 12 month of 80mg from India for $288. The US price is $1,596.

40 mg x 10 tablets - 4.5$
80 mg x 10 tablets - 8$

azilsartan is much better. You made the right choice. start with 20 mg. it does not have the side effects of telmisartan

 

[BP_6]

azilsartan is much better. You made the right choice. start with 20 mg. it does not have the side effects of telmisartan

That's good to know. Although I never noticed a difference in sides with the full 80mg dose "40mg in morning and evening just because I had 40's." Vs the Tel. Only real difference was the BP by a slight margin.

TM it would range from about 120-70/80 dropping down to as low as 114/67
With the Az it would be 115-70 to as low as 100/60. Which is fine for me as I want mine as low as I can go without becoming dizzy or other issues. If it was lower than that on average, I would lower the dose.

 

[BazzBeat]

That's good to know. Although I never noticed a difference in sides with the full 80mg dose "40mg in morning and evening just because I had 40's." Vs the Tel. Only real difference was the BP by a slight margin.

TM it would range from about 120-70/80 dropping down to as low as 114/67
With the Az it would be 115-70 to as low as 100/60. Which is fine for me as I want mine as low as I can go without becoming dizzy or other issues. If it was lower than that on average, I would lower the dose.

telmisartan during the day created pressure drops and slight dizziness. it is not suitable for all people. also telmisartan in some people will give side effects such as a red face, heat in the face, it can create a release of histamines.
by the way azilsartan is stronger in hematocrit control

 

[BamaCrazy]

azilsartan is much better. You made the right choice. start with 20 mg. it does not have the side effects of telmisartan

I found this study.

Efficacy and Safety of Azilsartan Medoxomil and Telmisartan in Hypertensive Patients: A Randomized, Assessor-Blinded Study - PubMed

This study found that AZL-M has greater antihypertensive efficacy than telmisartan, with comparable side effects. In addition, ABPM was shown to be a feasible method for such studies.

pubmed.ncbi.nlm.nih.gov

Conclusion: This study found that AZL-M has greater antihypertensive efficacy than telmisartan, with comparable side effects.

 

[BazzBeat]

I found this study.

Efficacy and Safety of Azilsartan Medoxomil and Telmisartan in Hypertensive Patients: A Randomized, Assessor-Blinded Study - PubMed

This study found that AZL-M has greater antihypertensive efficacy than telmisartan, with comparable side effects. In addition, ABPM was shown to be a feasible method for such studies.

pubmed.ncbi.nlm.nih.gov

Conclusion: This study found that AZL-M has greater antihypertensive efficacy than telmisartan, with comparable side effects.

Absolutely

 

[The Answ3r]

Not sure what’s going on lately - my blood pressure has always been solid, usually around 105–115 over 70–75, both on and off cycle. But for the past couple of days, it’s been jumping up to 125 over 96.

Nothing’s really changed on my end - diet’s the same, training and cardio are consistent (still doing an hour of cardio daily). I just took 20mg of Telmisartan, so I’ll see how my body responds, but honestly… it’s starting to stress me out a little.

 

[AlexDavis43]

Not sure what’s going on lately - my blood pressure has always been solid, usually around 105–115 over 70–75, both on and off cycle. But for the past couple of days, it’s been jumping up to 125 over 96.

Nothing’s really changed on my end - diet’s the same, training and cardio are consistent (still doing an hour of cardio daily). I just took 20mg of Telmisartan, so I’ll see how my body responds, but honestly… it’s starting to stress me out a little.

Good work on that cardio, keep it up

 

[BamaCrazy]

Not sure what’s going on lately - my blood pressure has always been solid, usually around 105–115 over 70–75, both on and off cycle. But for the past couple of days, it’s been jumping up to 125 over 96.

Nothing’s really changed on my end - diet’s the same, training and cardio are consistent (still doing an hour of cardio daily). I just took 20mg of Telmisartan, so I’ll see how my body responds, but honestly… it’s starting to stress me out a little.

The stress isn’t going to help bringing it down. I’ve found that worrying about my BP only made measuring it stressful which made my readings inaccurate. Do a 5 day audit taking your BP twice a day, morning and night. Sit for 5 minutes slowly breathing in and out before measuring your BP. Ensure the cuff is up near heart level.

It could be a temporary increase. Or you might be coming down with a cold and your symptoms haven’t appeared yet.

 

[The Answ3r]

The stress isn’t going to help bringing it down. I’ve found that worrying about my BP only made measuring it stressful which made my readings inaccurate. Do a 5 day audit taking your BP twice a day, morning and night. Sit for 5 minutes slowly breathing in and out before measuring your BP. Ensure the cuff is up near heart level.

It could be a temporary increase. Or you might be coming down with a cold and your symptoms haven’t appeared yet.

Thanks for the advice - really appreciate it. I’ll definitely start monitoring it more carefully over the next few days like you suggested, with proper rest and positioning before measuring. Hopefully it’s just temporary.

I did think maybe it was the modafinil at first - I only took 100mg, and just twice total, so I doubt it’s the main cause. Still, I’ve had this weird pressure in my temples that’s been bugging me. Could be stress, could be something else, but I’ll keep an eye on it and try to stay calm for now.

 

[BamaCrazy]

Thanks for the advice - really appreciate it. I’ll definitely start monitoring it more carefully over the next few days like you suggested, with proper rest and positioning before measuring. Hopefully it’s just temporary.

I did think maybe it was the modafinil at first - I only took 100mg, and just twice total, so I doubt it’s the main cause. Still, I’ve had this weird pressure in my temples that’s been bugging me. Could be stress, could be something else, but I’ll keep an eye on it and try to stay calm for now.

Moda can raise BP. It did for me that’s why I am avoiding moda and armoda. It has a 12-15 hour half life and can still be detected in your urine for up to 11 days.

How many days ago did you take it?

 

[The Answ3r]

Moda can raise BP. It did for me that’s why I am avoiding moda and armoda. It has a 12-15 hour half life and can still be detected in your urine for up to 11 days.

How many days ago did you take it?

Last Saturday and this Tuesday - both times around 7am, and then hit the gym about two hours later. I definitely noticed modafinil bumps up my heart rate, but I wasn’t expecting it to mess with my blood pressure like this.

Which is a bit tragic, honestly - I’ve got a 2-year supply of armoda on the way. If it turns out to be the cause, I might have to start selling it as a “limited edition pre-workout” instead.

 

[The Answ3r]

BP seems to be back on track - honestly, better than expected. Took the first reading this morning right after waking up, sitting nice and calm like a monk. Evening reading was about 30 minutes after cardio and my usual vitamin stack (aka Test, EQ, and Mast). All looking surprisingly solid now.

 

[BamaCrazy]

BP seems to be back on track - honestly, better than expected. Took the first reading this morning right after waking up, sitting nice and calm like a monk. Evening reading was about 30 minutes after cardio and my usual vitamin stack (aka Test, EQ, and Mast). All looking surprisingly solid now.
View attachment 327435

Still taking Moda?

 

[BP_6]

Just more anecdotal things I noticed. About 5 days ago, I changed my azilsartan dosage from 80mg "40mg 2x a day" to 40mg once a day before bed. Did this because I take 25mg of chlorthalidone as well. The combo product edarbiclor is max 40/25 which says is designed for people who the 80mg isn't enough and need a dual drug combo to meet their goals.

So made me think maybe the 80 was too much and not needed. So far 5 days in the 40mg is doing just fine with no changes other than my RHR has dropped 2-3 BPM on average. Sometimes if your blood pressure is getting too low the RHR can actually increase to compensate. So I think I will stick with the 40mg for now.

I still have my Teli as well if I go back. Gonna have to stick with PCT/24 until it becomes generic though as my insurance won't even cover brand edarbi. Teli is still the best for most though. Most people are unlikely to need the few extra HP of az.

Ironic the same company that currently produces az for the indian market is the same one that just got FDA approval for the generic version edarbi when it comes to the USA. It is approved and the patent has expired. Apparently though it still takes a bit of time.

 

[BP_6]

Since I got a bit of time, I thought I would share more info. Been on several different ARBs and BP meds over the last decade due to my kidney damage for being stupid and fortunately, it has not gotten any worse since I started controlling things.

Losartan. First ARB I ever used. Also the worst overall. Anything lower than the max 100mg dosage didn't do squat and I ended up having to split the dose or the next morning my bp would be too high. Not for me.

Valsartan. Did 80 then 160mg/day. Never went to the 320mg version. Worked a lot better than losartan at 160mg but caused my RHR to rise quite a bit. Didn't really like it, but it was acceptable.

Irbesartan. Did this at 150mg. Never got a chance to try the 300mg version. Due to insurance reasons is the reason I did this briefly. I actually liked it and it did a good job overall.

Olmesartan. This was actually pretty potent. At 40mg it was at least for me as strong, maybe a tad stronger than Telmisartan. However for some odd reason I kind of had digestion like issues on it. Could have not been related. I don't know. My new doc didn't like it and put me on Telmisartan.

Telmisartan. What I take now "well did ATM" and no need to say much. Worked well, very steady numbers.

Azilsartan. What I as you can see above have been testing. Strongest overall I have taken by a small margin. Seem so far to be very stable and as stable as Telmisartan despite a shorter half life. My blood work coming up will tell me more as I look at my lipids and a few other things. Nothing else to say except the pills have a very odd not too pleasant smell to them.

I'll do another post like this another time on my diuretic and Beta 2 blocker experience. I haven't done a CCB yet. Only because the Nebivolol seems to work fine with no real sides that I see and my insurance makes it easy and cheap to get. If I ever do switch, I will try the cilnidipine.

 

[Ghoul]

Small dose combos of different class BP meds have been the direction things have been going for a while. Sides are reduced or eliminated vs a higher dose of a single med, while BP reduction is effectively 1+1= 4, +1 more=6, etc. The leading edge is now 4 classes, ARB CCB Diuretic Beta Blocker, all in microdoses, much smaller than the starting dose of any of them, in a single pill. Sides are essentially non-existent, and BP control is excellent.

Upping the dose of a single med does the opposite. 20mg Telm provides 70% of the maximum BP reduction, 40mg 85%, 80mg 100%. Meanwhile the risk of sides quadruples from 20mg to 80mg.

The reason for this is easier to understand when you think of your vascular system as a series of different sizes and types of interconnected hoses. ARB primarily relaxes large arteries, CCB relaxes smaller arterioles, diuretic takes pressure off of veins and capillaries, beta blockers slow the pump.

I have a somewhat different situation. A dual combo ARB/CCB easily brings me to ideal BP with no sides. However, I wanted to max out Cilnipidine because the other benefits it provides work very well for me. The unique N calcium channel blocking completely resolved the Reynaud's (numb/cramping toes resulting from areterioles spasming from stress/cold hypersensitivity), drops my RHR by 5, and seems to provide anti-anxiety/ a sense of calm.

So I've had to lower my dose of Telm down to 20 in order to accommodate the higher dose of Cilnipidine.

 

[BP_6]

Small dose combos of different class BP meds have been the direction things have been going for a while. Sides are reduced or eliminated vs a higher dose of a single med, while BP reduction is effectively 1+1= 4, +1 more=6, etc. The leading edge is now 4 classes, ARB CCB Diuretic Beta Blocker, all in microdoses, much smaller than the starting dose of any of them, in a single pill. Sides are essentially non-existent, and BP control is excellent.

Upping the dose of a single med does the opposite. 20mg Telm provides 70% of the maximum BP reduction, 40mg 85%, 80mg 100%. Meanwhile the risk of sides quadruples from 20mg to 80mg.

The reason for this is easier to understand when you think of your vascular system as a series of different sizes and types of interconnected hoses. ARB primarily relaxes large arteries, CCB relaxes smaller arterioles, diuretic takes pressure off of veins and capillaries, beta blockers slow the pump.

Thank you for the info as always. I find it pretty interesting. I know also that apprently if needed you can take cilnidpline with nebivolol. If I ever do try that, I would lower the nebivolol down to 5mg and the cilnidipine as 5mg as well to start.

That being said, I know it is super new, but any thoughts on the next gen bp drug aprocitentan? Trivio. Works supposedly on a new mechanism.