The following article was formed with information taken from the r/steroids Wiki and a post made by Jcasaer369
Blood Pressure (BP) is a complex vital sign, and cannot be easily taught and all encompassed within even several pages of text. You could take an entire semester long course in college learning the physiology of blood pressure and still not know everything about it. The point of my post and this section of the wiki is NOT to completely educate anyone about BP, but to teach anyone willing to learn how to (fairly) easily manage their BP on their own without a doctor (although if you feel comfortable going to your doctor to get BP medication while on AAS, then by all means please do) and know a thing or two about what they are doing.
Different steroids WILL require different BP medications.
Trenbolone: This is where you will want Nebivolol 5 or 10 mg every day (or higher if need be, 20 mg being the highest you should ever go). Nebivolol is a selective (the most) beta blocker that will slow down the increased Heart Rate (HR) you experience on tren. As a beta blocker, Nebivolol is a bit more difficult to use than other BP medications, as it will require a taper off period.
The taper is SIMPLE.
Example: You are on 10 mg Nebivolol every day.
- Week 1 of the taper you will take 10 mg Nebivolol for 4 days, then 7.5 mg for 3 days
- Week 2 you will take 7.5 mg every day
- Week 3 you will take 5 mg every day
- Week 4 you will take 2.5 mg every day
- Week 5 you will take 2.5 mg every OTHER day
This taper guideline is a GENERAL EXAMPLE and can be customized to fit your own needs, but every taper should look fairly similar to this. Larger dosages will take longer to taper off of.
All other steroids: Use a simple ACE I such as Lisinopril or an ARB such as Losartan every day to manage BP. These drugs help the kidneys and liver function better as well. If this does not cut it, you must read my above post to consider duplicate (2 drugs) or triple therapy to manage your BP
But what about the amazing drug Telmisartan? NO. Telmisartan, though an ARB, has very powerful potassium increasing effects, which just complicates things. You can use Telmisartan if you want, but you must manage your potassium and electrolyte intake and get bloodwork to monitor it. Telmisartan is rarely prescribed alone, often with a diuretic to even out the increased potassium and because Telmisartan is a second line ARB for people who need extra BP control that Losartan or Lisinopril could not control
Disclaimer: all of the above from me are just RECOMMENDATIONS and ADVICE. I am not a doctor nor a medical professional, and you should trust their judgment (but also use your own) when managing your life and BP. If you do not feel confident that you know how to take BP meds after all your research, ask in the Ask anything threads for help, or go to a real doctor. Do not take them blindly
More on Blood Pressure
Taking your BP once a day is not enough, as this is only a time snapshot of what is occurring in your body. You want to take your BP 2-4 times per day. Ideally once in the morning, once in the afternoon, once before bed. The more the better.
When you take your BP, the first reading doesn’t count. You could be anxious, nervous, what have you. Take your BP a total of 3-4 times, with the first time not counting. Write down each reading, and average them. This is your current BP at that time.
Take your BP after 5 minutes of sitting and relaxing, doing something that calms you down. Watch a funny TV show, read a book, meditate, sudoku, whatever tiny little hobby you like. Heck read some Reddit. You want to be seated, straight up, back against support like a good chair, both feet planted flat on the floor. Your arm should be rested on a table of appropriate height, with your elbow 100% supported and you are giving no though or energy to keeping your arm up. Use a BP machine on your upper arm (no wrist ones) to take the readings. Make sure the cuff you are using is large enough.
BP should be managed FIRST with cardio done 5-7 days per week (the more the better) and an active healthy lifestyle and diet low in sodium and caffeine and ZERO other drugs of abuse. BP can then be attempted at management with supplements, such as CoQ10, hibiscus tea, Garlic extract, etc etc the list goes on. These supplements do very little/basically nothing for MOST people who are natural. Imagine how much they actually do for people on steroids, with AAS induced HTN. Most people on AAS are likely to encounter some time period that they need or should be on legitimate BP medications. Do not feel like you are a loser because you need real BP meds while on AAS. However, definitely try cardio and adding 1-2 supplements to your daily regimen to see if they help you before admitting defeat and taking real BP meds.
Hypertension (HTN or high blood pressure) is known as the silent killer, because you may never know you have it but it is very bad for your heart and body and organs. There is a way to possibly be able to tell your BP is high without taking it: when you lay down at night and everything is dark and calm and you are rested, and you can feel your veins pulsing and beating in your head or ears when you’re on the pillow, this is a plausible indicative sign your BP is too high, and you should start using a real machine to monitor it.
Blood Pressure Medication Guide by u/Jcaesaer369
I am a USA pharmacy school student in one of the top 10 USA pharmacy schools. I am going to detail what they taught us about BP meds and hypertension (this was a medical school level course) and what the FDA has medically approved as first and second line treatment options for hypertension. All of this information is taken from FDA approved online drug databases like Micromedex 2.0 and Lexicomp. These are large online drug databases that USA hospitals, doctors, and pharmacists use every day to reference drug information. Access to these websites is granted through my school, otherwise hospitals pay thousands of dollars a year to have access to these databases.
- Normal BP: 120 systolic / 80 diastolic mm Hg. Anything lower is good, too low ie heart failure is bad
- Pre-hypertension: 121-139/ 81-89 mm Hg
- Hypertension: 140-159 / 90-99 mm Hg
- Stage 2 HTN: >160 / >100 mm Hg. This is where HTN gets bad and damaging, hopefully you can treat before you get here
- Hypertensive emergency: 190-200 / 110-120 mm Hg. If your BP is consistently around here you should go to the ER so they can treat you with IV drugs. These BP levels can permanently damage your organs, including kidneys. Obviously BP readings over these levels are bad as well
There are 4 main categories of BP meds that are considered mono-treatment first line therapy, and also 1 main category of BP meds that is mono-treatment second line therapy but is the drug class of choice for drug induced hypertension.
All of these medications listed below are to be used as a last resort after failure to control BP from lifestyle modifications including: cardio 5-6 days a week, lowering dietary sodium to <2000 mg per day, ideally 1500 mg, limiting or eliminating caffeine, and getting adequate sleep. There are a plethora of supplements you can consider trying as well, including allicin from garlic, hibiscus tea, carditone, beet juice, etc. These supplements may work for some people, but will not work for everyone, as everyone is different.
Stacking rules for these medications: – Do not stack ACE I’s and ARBS.
- ACE I’s and a thiazide diuretic are a great stack
- ARBS and a thiazide diuretic are a great stack
- Do not frontload any of these meds, as this will exacerbate hypotension quite quickly
- Do not take more than 1 drug from the same drug class, it will only cause more severe side effects including nausea and vomiting and will not help with BP control
It should be noted that all of these drug recommendations are for while on gear and maybe during PCT, then come off the BP drugs and hopefully your BP will return to normal. I am not recommending anyone take these drugs for life. For B/C, you can take low doses of these BP meds for the cruise as well if needed.
1) ACE Inhibitors (angiotensin converting enzyme): These work by inhibiting ACE, thus preventing angiotensin I from being converted to angiotensin II. Angiotensin II is the big bad wolf in terms of BP, and causes vasoconstriction, increases water retention, and negatively affects a strained heart. These are not all of what angiotensin II does, but you get the idea that it is the main protein that we are trying to stop.
Options include: Lisinopril, Ramipril, Enalapril, etc.
Lisinopril dose levels are 5 mg, 10 mg, 20 mg, 40mg for the point of this sub.
Yes there is a 2.5 mg dose, and even an 80 mg dose, but the 2.5 is for LONG TERM control (ie entire lifetime) of BP and 80 mg is more difficult to dose and side effects usually become quite exacerbated at that dose.
Example therapy: Start at Lisinopril 5 mg by mouth every day at the same time upon waking, take this dose for 2 weeks and monitor BP. If BP has not gone down to desired goal, ramp dose up to next level, which is Lisinopril 10 mg. 2 weeks at 10 mg, then read BP. If still not in desired range, ramp up to 20 mg, then again to 40 mg. Most doctors will have patients wait an entire month before increasing dosages, but I will recommend 2 weeks as I know most of you will be looking for quicker BP control. If at any time you feel bad side effects that you do not like or can’t handle, bump the dose back down. Now you have found the correct dose for you for this drug class.
Now many of you are wondering, how long until the drug is fully kicked in? When this happens, it is called steady-state equilibrium, and for most normal drugs (like all we will talk about here) occurs at ~5 half lives assuming steady dosing. The half life for Lisinopril is 12 hours (average). That means it takes 60 hours to reach steady state. At this point, drug concentrations of Lisinopril in the body will be at their peak, and if you get side effects they will probably manifest at this point or well before. Side effects are usually rare for Lisinopril, that’s why it is so often prescribed. Nausea and vomiting/ uneasy stomach are a side effect for ALL DRUGS, do not be immediately alarmed by this, and take Lisinopril with food to help. The trademark annoying side effect of ACE I’s is a cough. This can be avoided by switching to an ARB, class 3 below.
2) Diuretics, specifically thiazide and loop diuretics. I am not going to delve into potassium sparing diuretics, as I believe they are beyond the scope of this sub, and often need to be stacked with another diuretic and require even more dietary restrictions. Diuretics essentially work by inhibiting a process in the kidneys, thus making you pee out salt, potassium, and water instead of reabsorbing them.
When taking thiazide diuretics, you should be moderately careful of how much potassium you consume, as you will lose electrolytes on HCTZ. Make sure you consume enough potassium for your dietary needs (a 2000 kcal diet should have 4500 mg potassium) and still drink enough water even while on diuretics.
Loop diuretics can help with edema (swelling of body parts due to excess water build up, most likely from orals) and will make you pee A LOT, very quickly. You lose a ton of potassium on loop diuretics, and I would recommend eating DOUBLE your normal potassium every day at least if you chose to take a loop diuretic. You can get potassium from starbucks energy drinks, muscle milks, milk, bananas, and potatoes. Or you can take a potassium supplement. Make sure you read ingredient labels and get enough K+. Those foods are just ones that have high potassium.
Thiazide diuretics, like hydrochlorothiazide (HCTZ) are the gold standard for diuretics for controlling BP. Chlorthalidone is actually better than HCTZ for long term control of BP, but this is a more exotic and expensive drug. I recommend getting chlorthalidone if you can, and dose it at 50 – 100 mg daily.
I will be using HCTZ as my example, as I have taken it myself and it is more commonly prescribed and easier to acquire.
Dosages for HCTZ are 12.5, 25, and 50 mg. Yes there is a 100 mg dose, but at this dose the drug becomes less effective and a loop diuretic is recommended.
HCTZ 12.5 mg per day at the same time for 2 weeks, check BP, if not in desired range then ramp up.
–Now loop diuretics, like the well known furosemide (Lasix). Loop diuretics are not usually used for blood pressure, but the optimal dosage for BP control is 80 mg furosemide taken by mouth once in the morning on an empty stomach 30 minutes before any food or calories, as furosemide works best on an empty stomach. This will make you pee every 20 minutes for about 3 ish hours, and the excess urination will last a total of 6 hours (Lasix, lasts 6 hours is how it got its name). Furosemide is more commonly used by athletes to quickly drop weight, or to look as shredded as possible for a competition.–
3) ARBs (angiotensin II receptor blockers): These work by blocking angiotensin II from binding to its receptors. ARBs are generally considered more powerful than ACE inhibitors (ofc this is dose dependent), and are still first line mono-therapy.
Options include Losartan, olmesartan, valsartan, etc.
Losartan dosages include 25, 50, and 100 mg every day
4) CCBs (calcium channel blockers) specifically the dihydropyridine class, like amlodipine besylate. This class of drugs works by blocking calcium channels, preventing calcium from entering the cell. This affects action potential and vasodilates blood vessels. The exact mechanism of action can be found through research and on Wiki for those truly interested.
Amlodipine dosages include 5 mg and 10 mg.
I feel 2.5 mg will be too low for many on this sub, and also will not provide quick enough BP control.*
CCBs are often stacked with other drugs, as dual or even triple therapy, but are also first line therapy by themselves. I am recommending them 4th because this is generally how the FDA indicates them as choices for BP meds, and they are less well known.
CCBs are BETTER for African Americans, and I would recommend CCBs FIRST to African Americans. This is not racist. The mechanism of action for this is not well understood, but studies have proven this and thus the FDA suggests this as well.
5) B (beta) receptor blockers, especially B 1 selective receptor blockers. You know how ephedrine speeds up your heart rate, causes vasoconstriction and is used for weight loss? It is through binding to B receptors as an agonist that ephedrine accomplishes these tasks. B agonists are bad for BP as they increase autonomic firing of the heart rate, and make blood vessels smaller. We want B 1 receptor antagonists, to do the opposite effects of greatly slowing heart rate and causing vasodilation. B blockers are not first line therapy, they are second line therapy for BP. However they are one of the best for drug induced hypertension, which is specifically what we are dealing with.
Options in order of decreasing selectivity for B 1 receptor: Nebivolol, Metoprolol, Atenolol.
Nebivolol is 300:1 selective for blocking B1 receptors over B2 receptors, and Metoprolol is 80:1 selective for blocking B1 receptors over B2 receptors. All Beta blockers will block both B1 and B2, but it is B1 we want blocked. B2 is associated with asthma and breathing, and blocking it MAY cause a slight decrease in metabolism. This is negligible as far as I consider it, but if you don’t like this, then go for the 4 drug classes listed above.
The best option is Nebivolol, which comes in strengths of 5, 10, or 20 mg.
The next best option is Metoprolol succinate (extended release) 100 mg by mouth once a day, or Metoprolol tartrate 50 mg by mouth twice a day. Both of these dosages may be ramped up, to 200 mg of Metoprolol maximum a day. 400 mg of tartrate may be done in 2 doses of 200 mg, but this is a high dose and may blunt heart rate too much and not lower BP significantly enough anymore.
B blockers can be used with great effect to combat increased heart rate on Tren, or after a cut from ECA/ other stimulants. B blockers ARE first line therapy for arrhythmias, but are used for longer term treatment (ie life) for this purpose.
I believe I have covered the main classes of drugs for BP and HTN here, thoroughly enough so that anyone can take them with a little bit of research and responsibility. Yes there are other heart conditions and other heart medications (many in fact) but these are rarer problems, and not as easily addressable as blood pressure. For all medications, start low and go slow. It will take 5 half lives for the BP med to be fully effective, and for some of these drugs like CCB’s this can take some time. I hope this post will serve everyone looking for information on BP medication well.