BP is probably the #1 meds we are taking. To arrive at optimal dose and combo could be enormously helpful to our longevity journey.
Please list your combo, dose, and why. And how is it working out for you.
I am taking Telmisartan 80 mg and Amlodipine 10 mg. My BP however at times still higher than optimal (110/70), especially when I am stressed and have not exercised for the day.
I’m considering reducing Amlodipine to 5 mg and adding 5 mg Bisoprolol as I would like to try this multi-agent and low-dose approach, which is very popular in Asia (China and India).
Bisoprolol, a β-blocker, has shown significant long-term benefits in cardiovascular health and longevity. In patients with hypertension, bisoprolol demonstrated increased survival compared to other β-blockers and non-β-blocker antihypertensives over a 15-year period (Sabidó et al., 2018). Similarly, in patients with angina, bisoprolol reduced the risk of mortality and cardiovascular events compared to other treatments over a 14-year follow-up (Sabidó et al., 2019). In high-risk patients who underwent major vascular surgery, bisoprolol significantly reduced cardiac death and myocardial infarction over a median follow-up of 22 months (Poldermans et al., 2001). These studies provide evidence supporting the long-term use of bisoprolol in various cardiovascular conditions.
However, there are studies not favorable on beta-blockers:
The review of 24 studies found that:
Beta-blockers (BB) post-MI reduce all-cause mortality by 11%, but with variability in results.
Patients event-free for one year post-MI on BB showed no mortality benefit or increased risk of MACCE.
Over time, especially post-2010, BB benefits have waned, with no mortality reduction in patients with preserved EF and possible increases in CV events and MACCE.
Conclusion: BB might not benefit and could harm patients with preserved EF long-term post-MI.
Mine jumps up much if I’m stressed. I’m taking a triple combo - amlodipine 2.5 mg, labetalol .25/twice a day, telmisartan 10mg - and it keeps me within a normal range. In stressful situations I take additional labetalol.
Beta blockers might increase insulin resistance or cause erectile dysfunction. Some are also associated with a higher risk of Parkinson’s (it might be causative although one recent MR study suggests it is for B2 blockers). It’s not a homogenous class so it’s hard to draw firm conclusions. They have different half lives and dosing schedules. Some only block B1, some block B1 and B2. Carvedilol also blocks Alpha1. Carvedilol and nebivolol are vasodilatators but not bisoprolol. High dose nebivolol lowered lifespan in the ITP. Carvedilol increased lifespan in mid life in worms (Ora Biomedical). See these discussions on this topic:
QUARTET USA used candesartan 2 mg + amlodipine 1.25 mg + indapamide 0.625 mg + bisoprolol 2.5 mg. QUARTET Australia used irbesartan 37.5 mg + amlodipine 1.25 mg + indapamide 0.625 mg + bisoprolol 2.5 mg.
(I’m taking telmisartan 80 mg + amlodipine 5 mg. I tried indapamide 1.5 mg SR but it messed up with my glycemic control. I’m using bisoprolol 2.5 mg to lower by ectopic beats, it also lowers my BP but it did increase my fasting glucose… I’ll try to discontinue it…)
I’ve been happy with Telmisartan 80 mg and Amlodipine 5 mg to optimize my BP. Well tolerated, no side effects. Adding a long acting low dose beta blocker would be a consideration if I needed another agent. I’d however have to seriously consider a low dose alpha blocker due to other benefits, particularly alfuzosin.
Good question - yes occasional checks of electrolytes are sensible - however, I’ve not seen any significant changes in my patients on 80 mg, and yes, we really need at least this for PPAR - if not 160 mg.
Hyponatremia is rare, Hyperkalemia is also rare unless you have renal impairment (e.g. an low GFR)
I’ve done a poor job on controlling my BP. I’ve been straightening out my lipids, which are now fine, so my attention is turning to BP. Diastolic weirdly low around 50 sometimes on awaking with 130 top number resting during the day.
I’m getting a carotid artery scan tomorrow. I’ve got both telmisartan and amlodipine on hand, so I’ll titrate those up. Main strategy is high intensity training with crazy high doses of the nase bros (nattokinase serapetase and lumbrokinase) plus the crazy low lipids, plus titrating BP meds I’ll learn more tomorrow with neck and tummy ultrasound, plus I think they’re doing the ankle-arm differential.
Incidentally the last time I went to a cardiologist was 30 years ago. I was getting all kinds of hell at work and needed time off. So I decided to fake a heart attack & went into the hospital complaining of chest pains. They did a blood test and said I had high troponin. They wanted to do a stent right then and there that afternoon. I delayed, told them I was afraid of surgery and would go home to rest. Before they relased me they did another troponin test and apparently it was ok now. Doc said maybe the first reading was off and sometimes that happens. Or maybe he was just really good at stents and wanted to practice his art, idk But anyway, I’m leary of cardiologists.
Angiotensin-converting enzyme inhibitors and calcium channel blocker in my research gave the best results. I take 20 mg Linsopril and 10 mg. Amlodipine. = BP below 100. Usually around 95-105. I am 79 yo. If I lose weight, I have to adjust to a lower dose. I weigh myself and take B/P every morning. I feel that low B/P is very important for long term health and longevity. Must monitor to not get below 90. My coronary calcium score was 23 one year ago. Not zero, but low for my age, Have scheduled CT angiogram with Calcium score and contrast next month. (1st. time) Have monitored plaque with yearly CIMT of cartoid arteries.
“Over a period of 10 years, the unadjusted risk for CVD for individuals with a baseline BP
of 120–129 mmHg was found to be 2.6 times higher than that in those
with a baseline systolic BP (SBP) in the lowest category (90–99 mmHg).”
The vast majority of papers conclude that ARBs lead to lower dementia and Parkinson’s disease rates than ACEis, and among ARBs, especially telmisartan.
For all-cause mortality, I don’t know if we have data though.
Some recent research on combined usage of bisoprolol and amlodipine:
Objective: Evaluate the effectiveness of combining bisoprolol and amlodipine in a fixed-dose (FDC) for hypertension.
Studies Reviewed:
One observational study,
Two randomized clinical trials (RCTs),
One indirect comparison.
Key Findings:
Observational & RCTs: FDC significantly improved BP control and patient adherence.
Indirect Comparison: FDC was as effective as high-dose monotherapy.
Conclusion: bisoprolol’s role in the FDC with amlodipine leverages its cardiac specificity and safety profile to enhance blood pressure control through a synergistic mechanism, offering a potentially more effective and tolerable option for managing hypertension.
I’ve been on telmisartan 80, amlodipine 5, and hawthorn extract. My BP today is 97/57. I switched from telmisartan 40 to 80 about two months ago and it took this long to see a response. Other factors in the delayed response: eliminating caffeine, which spikes my BP by 20 points, and a more faithful adherence to the renal diet.
Awesome. Out of curiosity, were you on anything else that could impact BP, for example SGLT2i are known to lower BP possibly by getting rid of sodium through kidneys. Taurine in 2g+ daily also can lower BP etc. When trying to lower BP it is useful to have a good sense of what the rest of your stack does, meds as well as supps and exercise etc.
I do take taurine, 6g per day, but I don’t think it’s affected my BP. I’m also a vegetarian, but I had been delinquent for a while. I’m back to being virtuous. A renal diet is low in sodium and I’m well below the recommended 2000mg/day. But I think I am too low. I get dizzy when my BP drops below 100.
