ARB vs ACE

[Stormwallace]

Greetings everyone. Just posting some anecdotal success with my blood pressure….
Been on an ACE-I for years. Diet/exercise dialed in but have a family hx of hypertension so the ace always helped keep it in check. Started TRT last year and it bumped up my BP, not crazy but worth addressing. Read a lot of info on here and other forums about ARB’s. Switched from Lisinopril to Olmesartan at same dose and after a couple weeks it’s markedly down, in a real comfortable range now. So glad I brought it up to my PCP and wish I would’ve sooner. I realize not everyone may have these results and nothing inherently bad with ACE-I, but it seems like I’m an ARB guy

 

[Ghoul]

Greetings everyone. Just posting some anecdotal success with my blood pressure….
Been on an ACE-I for years. Diet/exercise dialed in but have a family hx of hypertension so the ace always helped keep it in check. Started TRT last year and it bumped up my BP, not crazy but worth addressing. Read a lot of info on here and other forums about ARB’s. Switched from Lisinopril to Olmesartan at same dose and after a couple weeks it’s markedly down, in a real comfortable range now. So glad I brought it up to my PCP and wish I would’ve sooner. I realize not everyone may have these results and nothing inherently bad with ACE-I, but it seems like I’m an ARB guy

Except in special cases(ie chronic kidney diseases and others), for uncomplicated hypertension the latest cardiology treatment standards now all favor ARB over ACE.

Why olmesartan instead of telmisartan? In almost every case the later is better. Better kidney protection and metabolic benefits.

 

[Stormwallace]

Except in special cases(ie chronic kidney diseases and others), for uncomplicated hypertension the latest cardiology treatment standards now all favor ARB over ACE.

Why olmesartan instead of telmisartan? In almost every case the later is better. Better kidney protection and metabolic benefits.

Honestly didn’t question it which I obviously should have. Definitely not aware of the differences in specific ARB’s

 

[Ghoul]

Honestly didn’t question it which I obviously should have. Definitely not aware of the differences in specific ARB’s

Most docs have a favorite they "default" to.

I was on Valsartan, until I mentioned to my doc "I've read Telmisartan offers good kidney protection and metabolic benefits, would you mind switching me to the equivalent dose of that?". They should be fine with it. (and when you seem like a patient actively involved in your own healthcare, you're likely to get better treatment).

It's a cheap generic just like Olmasartan, and the only ARB that improves insulin sensitivity, which is a nice bonus.

 

[Sicsemptyran]

Why olmesartan instead of telmisartan? In almost every case the later is better. Better kidney protection and metabolic benefits.

Sounds like in this case it wouldn't be warranted, but olmesartan oftentimes can be a stronger effect for people than telmisartan especially on systolic BP.

Agreed that in almost everything but an edge case where you just need more blood pressure control (doesn't sound like in his case), telmisartan wins out. But just wanted to flag that as a reasonable edge case where it sometimes can make sense.

 

[Ghoul]

Sounds like in this case it wouldn't be warranted, but olmesartan oftentimes can be a stronger effect for people than telmisartan especially on systolic BP.

Agreed that in almost everything but an edge case where you just need more blood pressure control (doesn't sound like in his case), telmisartan wins out. But just wanted to flag that as a reasonable edge case where it sometimes can make sense.

You're not wrong, milligram to milligram, olmesartan reduces bp more. But milligrams doesn't really mean much. Valsartan 320mg and Telm 80mg are roughly equivalent, but neither is better or worse just because of the physical pill size.

The maximum dose of Olmasartan offers a little more bp reduction than Telm, but the truth is you should never be on the max dose of a single BP med. In fact Olmesartan max dose side effects are awful.

If a low or mid dose isn't enough, all the cardiology associations agree that best practice is to add a low dose of a second bp med in a different class, ie. ARG/CCB (preferably as a single pill combo).

When it comes to low dose, different class BP meds, it's 1+1=3 for efficacy, but side effects of a combo are equivalent to whatever the low dose risk is for either med.

There's really no reason to tolerate any BP sides for most people. Some dose/drug combo is out there that shouldn't cause any sides.

I'm going to take the opportunity here to mention amlodipine is the most likely second drug to be added. While it's pretty safe and effective, for long term health, you'd be better off throwing away the amlodipine and swapping in Cilnipidine from India instead. This is one of those cases where it's absolutely clear one med is superior in every aspect to another.

 

[BP_6]

Actually, I think olmearsartan shows actually "slightly" supposed better kidney protection. Thart being said, it is also has a higher chance of a nasty side effect of enteropathy and lacks some of the other benefits to the same extent of tele.

The only other ARB I have used and consider is Azilsartan. Have to get it through India though or you are going to be paying a lot. Strongest overall ARB there is. However its other benefits are not as well known as it being newer compared to the others, not as many studies. It does seem to be non-inferior as they say though in the other areas from initial studies.

That all being said, Tele for the benefit/price/performance IMO is the best overall. However, if you are on an ACE inhibitor and it is working well and you aren't getting the coughing or tongue swelling sides, you could probably be just fine sticking with it IMO.

 

[Ghoul]

Actually, I think olmearsartan shows actually "slightly" supposed better kidney protection. Thart being said, it is also has a higher chance of a nasty side effect of enteropathy and lacks some of the other benefits to the same extent of tele.

The only other ARB I have used and consider is Azilsartan. Have to get it through India though or you are going to be paying a lot. Strongest overall ARB there is. However its other benefits are not as well known as it being newer compared to the others, not as many studies. It does seem to be non-inferior as they say though in the other areas from initial studies.

That all being said, Tele for the benefit/price/performance IMO is the best overall. However, if you are on an ACE inhibitor and it is working well and you aren't getting the coughing or tongue swelling sides, you could probably be just fine sticking with it IMO.

Something to consider with ACE is that there's growing evidence of a modestly increased lung cancer risk with long term use. It's becoming less common for people to be started on ACE when ARBs are equally effective and avoid this potential risk,

 

[BP_6]

Something to consider with ACE is that there's growing evidence of a modestly increased lung cancer risk with long term use. It's becoming less common for people to be started on ACE when ARBs are equally effective and avoid this potential risk,

I was unaware of the lung cancer risk increase. I know a lot of old school cardiologist prefer the ACE as that is what they always used and there was until the last few years more data showing long term heart benefits with ACE vs ARB.

However that appears to have changed and now there is sold evidence both are equally effective in long term outcomes as you stated.

Personally, I suffered from a dry cough for a long time when I was younger for various things. The last thing I want is any drug that has that as its most common side effect.

 

[AlexDavis43]

Just FYI: we do so much shit to reduce body fat

They mechanism how telmisartan increases insulin sensitivity is via PPARg to increase the synthesis of new subq fat cells ready to suck in fat from other parts of your body like liver

The net effect is increased fat cells that tend to stick around for a while

PPARg agonists like rosiglitazone straight up make people fat (telmisartan doesn't do this outright but the predisposition is put into place)

Telmisartan is a much stronger PPARg agonist then candesartan and similar efficacy at BP reduction at their respective doses (40 mg telmi = 8 mg cande)

Telmisartan is much more accessible in the underground but if you're under a doctor's care or have a source for candesartan, just something to consider

 

[Zc7219]

Just FYI: we do so much shit to reduce body fat

They mechanism how telmisartan increases insulin sensitivity is via PPARg to increase the synthesis of new subq fat cells ready to suck in fat from other parts of your body like liver

The net effect is increased fat cells that tend to stick around for a while

PPARg agonists like rosiglitazone straight up make people fat (telmisartan doesn't do this outright but the predisposition is put into place)

Telmisartan is a much stronger PPARg agonist then candesartan and similar efficacy at BP reduction at their respective doses (40 mg telmi = 8 mg cande)

Telmisartan is much more accessible in the underground but if you're under a doctor's care or have a source for candesartan, just something to consider

Reading this on the max dose of Telm like


I was under the impression it helped with bodyfat.

 

[BP_6]

Reading this on the max dose of Telm like


I was under the impression it helped with bodyfat.

While it is nice to have, I don't think you will notice much of a benefit for bodyfat loss.

 

[Ghoul]

Just FYI: we do so much shit to reduce body fat

They mechanism how telmisartan increases insulin sensitivity is via PPARg to increase the synthesis of new subq fat cells ready to suck in fat from other parts of your body like liver

The net effect is increased fat cells that tend to stick around for a while

PPARg agonists like rosiglitazone straight up make people fat (telmisartan doesn't do this outright but the predisposition is put into place)

Telmisartan is a much stronger PPARg agonist then candesartan and similar efficacy at BP reduction at their respective doses (40 mg telmi = 8 mg cande)

Telmisartan is much more accessible in the underground but if you're under a doctor's care or have a source for candesartan, just something to consider

What is this based on? It's completely at odds with the human trials of Telmisartan's impact on fat distribution that collectively show significant visceral fat loss (10-15%) and no change in subQ fat volume.

 

[Nidus]

What is this based on? It's completely at odds with the human trials of Telmisartan's impact on fat distribution that collectively show significant visceral fat loss (10-15%) and no change in subQ fat volume.

Maybe he is taken this from Pioglitazones and their shift of fat allocation which is associated with Telmisartan as both technically trigger the same receptors and it be misleading but not 100% proven