Recovery line · cardiovascular

Blood Pressure
& Telmisartan

Restart protocol and the daily reading ritual. Supersedes the 7/8 assessment, which was built on a filtered export.

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Starting today · 7/9

Telmisartan 40 mg

6:30 AM, with the Rx cluster. Steps to 80 mg on July 16.

Every morning · 5:55 AM

Before telmisartan, before Adderall, before omeprazole, before anything.
Sit for five minutes. Feet flat, back supported, don't talk.
Bare arm. Cuff at heart level.
Take three readings, one minute apart.
Throw out the first. Average the second and third.
Log it in Apple Health.

1discard

2log

3log

The first reading runs high in some sessions and low in others. It is never the number.

Never analyze the iHealth PDF export. It dropped 21 of your 39 readings — and it dropped the high ones. Apple Health is the source of truth.

Also · 1:30 PM · through 7/15

One seated reading, 90 minutes after the noon meal. This is where your pressure falls to 115/50. It watches the postprandial trough while the dose climbs.

The ladder

Jul 9–15 40 mgRe-entry week. Hgb is at its nadir and citrulline is active.

Jul 16 → 80 mgFull dose. This is where the PPAR-γ effect lives — it matters for Type 3c.

Jul 30 Read the dataTwo weeks of morning averages at 80 mg.

~Aug 1 LabsUACR, BMP (Na, K), CBC (Hgb trend).

Stop rules

Any postprandial reading below 100/55. Hold at 40 mg. Don't step up on July 16.

Lightheaded on standing. Hold at 40 mg. Message Dr. Kuhlman.

Any reading at or above 180/120. Urgent care. Not a message, not a wait.

Morning average still ≥130 after two weeks at 80 mg. Escalate. A second agent, or ABPM first.

What changed

Potassium citrate — do not start. K was 4.6 unsupplemented. In a K-replete person a potassium load is natriuretic, and you just reached Na 134 for the first time. Cut from all three meals.
Truvaga Plus — moved to mid-August from July 28. Restart after 80 mg settles. Morning, fasted, never after a meal. One 2-minute bilateral session to begin.
L-Citrulline is now additive. NO-mediated vasodilation stacks on RAS blockade. It's why the 1:30 PM reading exists.
Adderall is 60 mg XR-only. Ten milligrams below the load you carried while prescribed telmisartan 80. The stimulant is not the pressor.

Portal message to Dr. Kuhlman

Three facts only they can produce. One record correction.

UACR on the August draw. Microalbuminuria means RAS blockade is indicated regardless of what the cuff says.
Orthostatic vitals — supine, then at 1 and 3 minutes standing. Postprandial hypotension plus Type 3c is a screenable pattern.
24-hour ABPM. It settles the dose question in a day instead of two weeks.
Document the hold and the restart. The chart says telmisartan 80 mg daily. You were taking zero, at 149/74 fasted. It was a perioperative hold nobody reconciled — not a discontinuation.

Baseline · 39 readings · Jul 4–8

All readings, raw mean: 136.8 / 67.8
Session means, first discarded: 135 / 67
Fasted, pre-dose: 138 / 68
Jul 5, 9:16 AM · 5 readings: 149 / 74
Postprandial range: 115–128 / 50–62
Pulse pressure (fasted): ~68 mmHg
Adderall: 60 mg XR

Two blood pressures, not one. Fasted 138–152 / 68–80. Ninety minutes postprandial, 115–128 / 50–62. A >35 mmHg fall. The low readings were meals — never the drug working.

BP + Telmisartan · rev 1.0 · 7.9.2026
supersedes the 7/8 assessment, built on a filtered export
never acetaminophen · never NSAIDs · no soy