Elevated systolic blood pressure, even on BP meds. Any ideas?

[twothirtytwo]

Curious to see if anyone has experienced what i am now and successfully resolved it.
About me:
33m 6ft 1 190lbs
Very active, (train BJJ and lift 3-4 times a week)
Healthy diet, social drinker
Test cyp 120mg a week (split into 3 doses t/thur/sat) HCG 1000iu a week, (also split into 3 doses).
Latest labs:
CBC/CMP everything normal and within range
SHBG low 10.8 (this has been low every time ive ever had it checked)
Free test calculated: 19.96 (scale 2.20-20)
TT: 698 (249-836 range)
Bioavailable test: 572 (15-575)
E2 40.1 (11.3-43.2)

Here's where it gets interesting.
I was on TRT via gel from 2016-2020 (before hoping on my total test was 190). During this time at annual physicals my bp was always normal. In Sept 2020 I switched to injections. Around the same time, I developed high blood pressure. I was getting home readings of 150s/90s. At first i thought it was the injections causing the spike, so i came off of TRT for 8 weeks. BP did not go down and had all the low T symptoms so started bp medication and hopped back on TRT. With BP meds i have tried amlodipine (which i did not respond great to and had the side effect of very noticeable ankle swelling), bumped up to enalapril + amlodipine, on this BP was running 130s / 60/70s.

Not enjoying the ankle swelling side effect and searching for a solution to get systolic under 120, started trying other meds (all prescribed by a doctor). Have tried a mix of various ARBS + HCTZ. Was on losartan 100mg + hctz 25 and getting readings of 140s/60s-70s. Last week switched to taking telmisartan 80mg + 25mg HCTZ. Diastolic BP is normal, 60s-70s, but systolic can be anywhere from 135-145. Sometimes ill even see it in the 150s, but a few deep breathes and rechecking brings it down slightly. Ideal is considered under 120 and its honestly been over 2 years now since Ive gotten a reading that low. Going to follow up with my doctor tomorrow to see if he can suggest any other meds to try since the switched from losartan to telmisartan didnt make a difference, but thought id check here to see if anyone had any suggestions.

I have also tried supplements l-citrulline and l-arginine (still taking since i have on hand) which ive read can help lower BP, but i do not appear to respond in any way to it. Will just also add resting pulse is in the 60s when awake and drops to the 40s when sleeping.

Any suggestions on what to try to bring systolic bp down?

 

[Fernando Almaguer]

Sauna, more cardio like 3 miles weekly or biweekly, try another medication like lisinopril or an arb. Get plenty of sun, especially in the morning without a window to help regulate sleep.
Just some ideas that come to mind.

 

[Belekas]

Maybe you are asking the wrong questions, your levels are at the top of the range and maybe your body don't respond well being there in regarding to the elevated BP you get? Also you have HcG in there which I would drop also when trying to manage the variables. Seems 95% of folks that get problems never look into the main culprit being the amount of test they inject. To me it's crazy to start eating pills like candies at 33 years old but I guess your doctor knows better

 

[twothirtytwo]

Re levels being top of the range, i came off TRT and HCG, everything for 8 weeks and blood pressure remained high, so i do not think it is TRT related.

Re carido, I train Brazilian jujitsu 4-7 times a week for 2 hour classes where i literally sweat up to 7 pounds in once class. BJJ is a very intense cardio work out, so my BP is not a manner of being inactive. I also supplement with vitamin d. On labs levels are always in the 60s, on normal range of 30-100.

Appreciate the tips, but nothing seems to be working to get my bp in an ideal range, not even meds.

Will see what doctor says, but was just curious if anyone else experienced stubborn high systolic bp and how they resolved it. I already get plenty of cardio, avoid salt, and am on meds so im getting pretty frustrated by this.

 

[Belekas]

If you sweat a lot and avoid salt that might be a big problem. Salt is essential especially if you sweat a lot. Also you might be overtrained, have you tried reducing it? Also might be underfed as well, as we see this in a lot of people. Before TRT you also had it high?

 

[JmarkH]

How are your potassium levels? Too low or too high, and the heart doesn't react well. Prescription bp water pills deplete potassium.

 

[ajax31]

Since you've been off TRT for 8 weeks, test E2 again. I'm suspicious of that. Also, make a list of everything you've taken - including supplements - since the blood pressure went up. As @JmarkH said, your electrolytes might be out of balance.

I would go back and test E2 again, and do a CBC with Comprehensive Metabolic Panel (CMP).

Edit: and an Iron Panel, too.

 

[twothirtytwo]

to clarify the timeline here:
Started TRT in 2016 on gel with normal bp (TT was 190 before hoping on)
Switched to injections in 2020 and noticed high BP around this time (150s/90s)
Thought it was injection related to paused TRT for 8 weeks 2 years ago in 2020. BP remained high, so resumed TRT.
Added BP meds in Oct 2020 and tried various different ones to get BP to ideal range, nothing is working. Labs i posted above were as of a few weeks ago.

Potassium is normal, on last labs is 4.4 (range of 3.5-5.1).
Even on weeks where I train less, or even take a week off due to vacation, blood pressure does not change, so do not think it is due to over training.

Dr. suggested adding a 2nd diuretic to the mix and running labs in 2 weeks to see how 2nd diuretic effects potassium levels. So total meds starting tomorrow will be telmisartan 80mg HCTZ 25mg spironolactone 25mg. BP as of today before adding spironolactone is 140s/70s.

 

[ajax31]

The edema and upper range estradiol may be related.

As I said, I would get another E2, CBC, CMP, Iron Panel and RBC magnesium before committing to a lifetime of BP meds and diuretics.

 

[twothirtytwo]

Appreciate your response. CBC, CMP, Iron, RBC and Magnesium are all within range and checked 3 weeks ago. Iron in the past has been low due to donating blood too often, but these days i donate once a year, if that, and its been normal.
RBC 5.82 (4.5-6.5 range)
Magnesium 2.0 (1.7-2.3 range)

When i first discovered high BP I also suspected it was E2 related. I took too much AI and had labs where E2 was below range. Labs again where E2 was in normal range. And labs where E2 was high. In all three instances there was no notable correlation to BP changes.

 

[ajax31]

Appreciate your response. CBC, CMP, Iron, RBC and Magnesium are all within range and checked 3 weeks ago. Iron in the past has been low due to donating blood too often, but these days i donate once a year, if that, and its been normal.
RBC 5.82 (4.5-6.5 range)
Magnesium 2.0 (1.7-2.3 range)

When i first discovered high BP I also suspected it was E2 related. I took too much AI and had labs where E2 was below range. Labs again where E2 was in normal range. And labs where E2 was high. In all three instances there was no notable correlation to BP changes.

Did you check cortisol?

 

[twothirtytwo]

i have not had cortisol checked. ill have in checked in 2 weeks when i do next labs

 

[Nelson Vergel]

I have the same issue. I have come to accept 140/87 as good BP for me. On amlodipine 10 mg plus losartan now. Diuretics work the best but I hate getting up more than once per night to pee since it is very disruptive to my sleep quality.

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