Blood Pressure/Hypertension not dropping

[Such1943]

However, for people with a history of high A1C (presumably many on this forum), indapamide is probably better than chlorthalidone. because it controls BP just as well, but with less metabolic/electrolyte disturbance.

I’m going to look into indapamide. I just had recent blood work on Monday, and it looks like HCTZ might be contributing to low potassium levels, even though I am chugging electrolytes like it's going out of style. It may also be negatively influencing some lipid markers and insulin sensitivity (fasting glucose of 87 mg/dL, Reta is taking care of this for me). I reviewed the labs with Dr. AI. On TRT+ (200mg Test, 150mg Primo and 4UI HGH. Lol TRT+ mild AAS cycle). Blood work was done before cycle to dial in IGF-1 (1 week in, 7 months on just 180mg Test). I'll find out more when I get another blood panel in 6 weeks. 115/70 this morning.

 

[diogenes]

Indapamide has slightly less hypokalemia (low K) risk than HCTZ or chlorthalidone, but it's not a game changer. All three are thiazide or thiazide-like diuretics—they do essentially the same thing. So switching to an equivalent dose of indpamide won't raise your potassium by much.

How low is your potassium (K)? Your telmisartan should raise K, so the fact that it's still low is noteworthy.

If it's just a bit too low, you might consider switching to 1.25mg indapamide. Your K will probably go up a bit, and your BP will have better 24 hour control than on HCTZ.

But if your K is way too low, you might not tolerate thiazide diuretics well. There are a few options, among them:

• just lower the HCTZ to 12.5mg. Your BP wlll climb a bit, but you'll have a good deal more K and maybe less fasting glucose. This is the "good enough for government work" solution.
• add amiloride or triamterene to your HCTZ/indapamide/chlorthalidone/whatever. This increases K and adds some more BP control. It's esp common for older patients. But whether it's a good idea for you depends on your kidney numbers bla bla bla bla and you need to ask your doctor (actually)
• switch to a potassium sparing diuretic. Again, whether this is a good idea depends on specifics about your kidney function. You're presumably male, so don't let them feed you spironolactone: it can make your dick soft and your skin girlish—perish the thought.
• switch from diuretics to some other class of drug. There is a whole zoo of lesser known but perfectly servicable antihypertensive drug classes: beta blockers, alpha2 agonists, alpha1 blockers, renin inhibitors, you name it. Some of my faves include:
  • nebivolol (beta blocker). Unlike older beta blockers, it's metabolically alright, long acting, erection friendly, and doesn't make exercise much harder. Most of the shit people talk about beta blockers doesn't apply to nebivolol.
  • prazosin (a1 blocker). Works well, may help sleep (esp nightmares), may help overall mental chillness, very safe. Start with a super low dose or it'll make you dizzy.
  • guanfacine ER (a2 agonist). Works. Safe. Enhances your calm. Improves your attention span. Might make you tired.

 

[Such1943]

How low is your potassium (K)? Your telmisartan should raise K, so the fact that it's still low is noteworthy.

January 5th blood draw: Potassium: 3.3 mmol/L. Quest Diagnostics standard: 3.5–5.3 mmol/L. Just under, nothing crazy. I might cut my HCTZ in half and request Indapamide at my yearly check up. Numbers were 110/66 this morning.