Re: Off Spiro and blood pressure has remained low!

[Guest guest]

If you read my thread, you will see that I experienced a lot of fire and flight. Have you experienced anything similar prior to Spiro? Any Allergic reactions? Becareful, other diuretics could rob you of Potasium, mine went down to 2.9 with them, and at one point, I was taking 20 MEQs to bring it backup to 3.5

I do have a growth on one of my Adrenals, but they claimed it insignifcant.

Marlwood321 <lwood321@...> wrote:

I went off spironolactone on March 6 (to prep for getting pregnant andgoing onto a safe blood pressure med)and my bp has remained low eversince (~117/76). I saw my endocrinologist a week ago. She took atblood sample to test my K levels. If my potassium is ok, then she'sgoing to test my renin and aldo levels. When I was originally diagnosed, my bp was as high as 150/115. Mypotassium levels were never very low, just slightly less than normal.My renin and aldosterone levels were off, but I don't remember thenumbers. A MRI didn't show any tumors on either adrenal gland (now Iknow a CAT scan is better).I'd love to think that I healed myself, but I'm not sure what's goingon. Let me know if you have any theories. I'll fill you in on therenin/aldosterone test when I get the results.

Thanks,

[Guest guest]

I haven't experienced anything quite as dramatic as you. I'm super

itchy where I shave, but the itchiness has not decreased much since I

stopped taking spiro, so I don't think it's a side effect. No

spookiness. I don't think I had any side effects from spiro except

having to pee more often, especially after drinking caffeine. I was

very lucky.

If my bp does go back up and I need to go on different meds, then I'm

sure my doc will monitor my K levels.

Good luck!

leslie

> I went off spironolactone on March 6 (to prep for getting pregnant and

> going onto a safe blood pressure med)and my bp has remained low ever

> since (~117/76). I saw my endocrinologist a week ago. She took at

> blood sample to test my K levels. If my potassium is ok, then she's

> going to test my renin and aldo levels.

>

> When I was originally diagnosed, my bp was as high as 150/115. My

> potassium levels were never very low, just slightly less than normal.

> My renin and aldosterone levels were off, but I don't remember the

> numbers. A MRI didn't show any tumors on either adrenal gland (now I

> know a CAT scan is better).

>

> I'd love to think that I healed myself, but I'm not sure what's going

> on. Let me know if you have any theories. I'll fill you in on the

> renin/aldosterone test when I get the results.

>

> Thanks,

>

>

>

>

>

>

>

>

>

[Guest guest]

Hi :

I was just wondering how long you were on Spiro before you stopped? And was your bp as low when you were on spiro?

This sounds like a success story to me. I hope you never have to take any medications.

Farah

lwood321 <lwood321@...> wrote:

I went off spironolactone on March 6 (to prep for getting pregnant andgoing onto a safe blood pressure med)and my bp has remained low eversince (~117/76). I saw my endocrinologist a week ago. She took atblood sample to test my K levels. If my potassium is ok, then she'sgoing to test my renin and aldo levels. When I was originally diagnosed, my bp was as high as 150/115. Mypotassium levels were never very low, just slightly less than normal.My renin and aldosterone levels were off, but I don't remember thenumbers. A MRI didn't show any tumors on either adrenal gland (now Iknow a CAT scan is better).I'd love to think that I healed myself, but I'm not sure what's goingon. Let me know if you have any theories. I'll fill you in on therenin/aldosterone test when I get the results.

Thanks,

[Guest guest]

Pregnancy should help to keep your pressure normal if you don't have any complications. I guess the hormones react to the aldosterone and lowers it. I had/have PA and my pressure was completely normal during pregnancy. 3 days after delivery each time it started to go back up. good luck.

Off Spiro and blood pressure has remained low!

I went off spironolactone on March 6 (to prep for getting pregnant andgoing onto a safe blood pressure med)and my bp has remained low eversince (~117/76). I saw my endocrinologist a week ago. She took atblood sample to test my K levels. If my potassium is ok, then she'sgoing to test my renin and aldo levels. When I was originally diagnosed, my bp was as high as 150/115. Mypotassium levels were never very low, just slightly less than normal.My renin and aldosterone levels were off, but I don't remember thenumbers. A MRI didn't show any tumors on either adrenal gland (now Iknow a CAT scan is better).I'd love to think that I healed myself, but I'm not sure what's goingon. Let me know if you have any theories. I'll fill you in on therenin/aldosterone test when I get the results. Thanks,

[Guest guest]

I've read that PA symptoms should improve when pregnant, but mine did the opposite. When I was pregnant, my BP went up significantly. I was on Methyldopa for BP during pregnancy and labor. Prior to being pregnant, my BP averaged around 140/100. During pregnancy, I had severe edema and BP got up to around 180/120 while I was working. I'm told it got higher but don't know the numbers. It stayed around 160/105 afterward and a year or two later is when I was diagnosed with PA. If you have a history of HTN and are now questioning if PA is the right DX, make sure to keep a close eye on your BP during a pregnancy.

Best wishes to you!

The other

Off Spiro and blood pressure has remained low!

I went off spironolactone on March 6 (to prep for getting pregnant andgoing onto a safe blood pressure med)and my bp has remained low eversince (~117/76). I saw my endocrinologist a week ago. She took atblood sample to test my K levels. If my potassium is ok, then she'sgoing to test my renin and aldo levels. When I was originally diagnosed, my bp was as high as 150/115. Mypotassium levels were never very low, just slightly less than normal.My renin and aldosterone levels were off, but I don't remember thenumbers. A MRI didn't show any tumors on either adrenal gland (now Iknow a CAT scan is better).I'd love to think that I healed myself, but I'm not sure what's goingon. Let me know if you have any theories. I'll fill you in on therenin/aldosterone test when I get the results. Thanks,

[Guest guest]

On Apr 29, 2005, at 1:49 PM, Mar wrote:

> If you read my thread, you will see that I experienced a lot of fire

> and flight. Have you experienced anything similar prior to Spiro? Any

> Allergic reactions? Becareful, other diuretics could rob you of

> Potasium, mine went down to 2.9 with them, and at one point, I was

> taking 20 MEQs to bring it backup to 3.5

> I do have a growth on one of my Adrenals, but they claimed it

> insignifcant.

>  

I don't know how they can tell w/o adrenal vein sampling, including the

ACTH stimulus. My CT's came out w/one mass, but the postop path

report showed two (the CT missed the bigger one because it was more

diffuse), and general hyperplasia, also missed by the CT. Blood &

urine are suggestive, but not definitive. As is excess alkalinity

(like kidney stones, salty perspiration, etc), or resistance to BP

meds. There are many things which can be causing excess aldo, low K,

and/or renin or cortisol oddities. And these may all be what they call

" labile, " just like BP itself. Spiking up and down when the needle

isn't in your arm. 24-hr urines (there are 3, I believe) help with

this variance problem. I have done as many as 3 x 3 to get a picture

because my levels vary so much.

I'd listen to Dr Grim about the testing.

Dave

[Guest guest]

May be that you are DASHing better.

PA gets better with Preg due to antagonistic effect of high progesterone. There is a rare genetic sydrome which causes HTN of preg in which the mineralocorticoid receptor has mutated so that progest occupies it and activates ENaC and HTN and low K results during pregnancy.

CEG

In a message dated 4/30/05 6:40:19 AM, spirlhelix@... writes:

Hi, Heidi

I have read articles which said PA patients' blood

pressure tends to normalize while pregnant, for the

reasons you named.

I'm glad you had a good experience!  Thank you for

sharing.

Warmly,

Pam

--- Heidi Rankin <hj.rankin5@...> wrote:

> Pregnancy should help to keep your pressure normal

> if you don't have any complications. I guess the

> hormones react to the aldosterone and lowers it.  I

> had/have PA and my pressure was completely normal

> during pregnancy. 3 days after delivery each time it

> started to go back up. good luck.

>   Off Spiro and blood

> pressure has remained low!

>

>

>   I went off spironolactone on March 6 (to prep for

> getting pregnant and

>   going onto a safe blood pressure med)and my bp has

> remained low ever

>   since (~117/76). I saw my endocrinologist a

> week ago.  She took at

>   blood sample to test my K levels.  If my potassium

> is ok, then she's

>   going to test my renin and aldo levels.

>

>   When I was originally diagnosed, my bp was as high

> as 150/115.  My

>   potassium levels were never very low, just

> slightly less than normal.

>   My renin and aldosterone levels were off, but I

> don't remember the

>   numbers.  A MRI didn't show any tumors on either

> adrenal gland (now I

>   know a CAT scan is better).

>

>   I'd love to think that I healed myself, but I'm

> not sure what's going

>   on.  Let me know if you have any theories.  I'll

> fill you in on the

>   renin/aldosterone test when I get the results.

>

>   Thanks,

>  

>

>

>

>

>

>

------------------------------------------------------------------------------

>  

[Guest guest]

In a message dated 4/30/05 5:40:24 AM, dave@... writes:

It can't, and that's one of my points.  Only in a post-op adrenalectomy

lab dissection.  Although on the CT, my right one looked normal in

every way except for a 1CM adenoma (which was found in the lab, gold in

color, the hallmark of PA, but not always) and  was distended to about

50% bigger, with this CT-invisible diffuse mass.  Weighed more than

usual too.  Hyperplasia was caused, in this case, by a diffuse mass. 

The entire gland was enlarged, but not hyperplasic.  A large portion of

it was though, so functionally hyperplasic.  Now that I have had dex

suppression & genetic Yale test for GRA, and resistance to BP meds plus

3 different 24-hour urines, it seems clear the left one is too,

although on CT it looks perfect.  So, I was BAH incorrectly diagnosed,

and they took out my right gland w/o AVS.

Review my evolution article and you will see the problem. Big adenomas come from small adenomas and these likely came from single cells that went haywire for an unknown reason and big hyperplasia comes from smaller hyperplasia etc.

It is a continum than cannot be easily separated-indeed cannot be separated with current tests-ie where do you make the cut off?

Thus my approach to give spiro or Inspra etc and only if BP cant be controlled or side effects are intolerable or K cant be controlled do I go to AVS.

May your pressure be low!

Clarence E. Grim, BS (Chem/Math), MS (Biochem), MD, FACP, FACC, FAHACHBPR

Charter member of American Society of Hypertension(ASH) and the International Society for Hypertension in Blacks (ISHIB).

Clinical Professor of Medicine and Epidemiology

Director, Hypertension Diagnosis and Treatment Center

Board Certified in Internal Medicine, Geriatrics and Hypertension

Published over 220 scientific papers, book chapters and 220 abstracts

in the area of high blood pressure epidemiology, physiology, endocrinology, measurement, treatment and how to detect curable causes.

Listed in Best Doctors in America

Specializing in Difficult to Control High Blood Pressure and the

History and Physiology of High Blood pressure in the African Diaspora

Member of the Board of Directors, ISHIB

[Guest guest]

In a message dated 4/30/05 5:40:24 AM, dave@... writes:

It can't, and that's one of my points.  Only in a post-op adrenalectomy

lab dissection.  Although on the CT, my right one looked normal in

every way except for a 1CM adenoma (which was found in the lab, gold in

color, the hallmark of PA, but not always) and  was distended to about

50% bigger, with this CT-invisible diffuse mass.  Weighed more than

usual too.  Hyperplasia was caused, in this case, by a diffuse mass. 

The entire gland was enlarged, but not hyperplasic.  A large portion of

it was though, so functionally hyperplasic.  Now that I have had dex

suppression & genetic Yale test for GRA, and resistance to BP meds plus

3 different 24-hour urines, it seems clear the left one is too,

although on CT it looks perfect.  So, I was BAH incorrectly diagnosed,

and they took out my right gland w/o AVS.

Review my evolution article and you will see the problem. Big adenomas come from small adenomas and these likely came from single cells that went haywire for an unknown reason and big hyperplasia comes from smaller hyperplasia etc.

It is a continum than cannot be easily separated-indeed cannot be separated with current tests-ie where do you make the cut off?

Thus my approach to give spiro or Inspra etc and only if BP cant be controlled or side effects are intolerable or K cant be controlled do I go to AVS.

May your pressure be low!

Clarence E. Grim, BS (Chem/Math), MS (Biochem), MD, FACP, FACC, FAHACHBPR

Charter member of American Society of Hypertension(ASH) and the International Society for Hypertension in Blacks (ISHIB).

Clinical Professor of Medicine and Epidemiology

Director, Hypertension Diagnosis and Treatment Center

Board Certified in Internal Medicine, Geriatrics and Hypertension

Published over 220 scientific papers, book chapters and 220 abstracts

in the area of high blood pressure epidemiology, physiology, endocrinology, measurement, treatment and how to detect curable causes.

Listed in Best Doctors in America

Specializing in Difficult to Control High Blood Pressure and the

History and Physiology of High Blood pressure in the African Diaspora

Member of the Board of Directors, ISHIB

[Guest guest]

In a message dated 4/29/05 10:16:23 PM, farahbar@... writes:

How can a CT scan show hyperplasia? If there is "no standard" adrenal gland size, how can a CT scan show BAH? Unless both adrenals have adenoma? I am confused.

Big hyperplasia causes big bumps so they can be seen on imaging methods. Adenomas the size of a small pea can cause PA but cant be seen on any methods we have today.

May your pressure be low!

Clarence E. Grim, BS (Chem/Math), MS (Biochem), MD, FACP, FACC, FAHACHBPR

Charter member of American Society of Hypertension(ASH) and the International Society for Hypertension in Blacks (ISHIB).

Clinical Professor of Medicine and Epidemiology

Director, Hypertension Diagnosis and Treatment Center

Board Certified in Internal Medicine, Geriatrics and Hypertension

Published over 220 scientific papers, book chapters and 220 abstracts

in the area of high blood pressure epidemiology, physiology, endocrinology, measurement, treatment and how to detect curable causes.

Listed in Best Doctors in America

Specializing in Difficult to Control High Blood Pressure and the

History and Physiology of High Blood pressure in the African Diaspora

Member of the Board of Directors, ISHIB

[Guest guest]

In a message dated 4/29/05 10:07:54 PM, dave@... writes:

Potasium, mine went down to 2.9 with them, and at one point, I was

> taking 20 MEQs to bring it backup to 3.5

Just got some low Na V=8 that has 20 mEQs of K (640 mg) in it. Tastes pretty good-like homemade tomato juice.

CEG

May your pressure be low!

Clarence E. Grim, BS (Chem/Math), MS (Biochem), MD, FACP, FACC, FAHACHBPR

Charter member of American Society of Hypertension(ASH) and the International Society for Hypertension in Blacks (ISHIB).

Clinical Professor of Medicine and Epidemiology

Director, Hypertension Diagnosis and Treatment Center

Board Certified in Internal Medicine, Geriatrics and Hypertension

Published over 220 scientific papers, book chapters and 220 abstracts

in the area of high blood pressure epidemiology, physiology, endocrinology, measurement, treatment and how to detect curable causes.

Listed in Best Doctors in America

Specializing in Difficult to Control High Blood Pressure and the

History and Physiology of High Blood pressure in the African Diaspora

Member of the Board of Directors, ISHIB

[Guest guest]

Hi, Heidi

I have read articles which said PA patients' blood

pressure tends to normalize while pregnant, for the

reasons you named.

I'm glad you had a good experience! Thank you for

sharing.

Warmly,

Pam

--- Heidi Rankin <hj.rankin5@...> wrote:

> Pregnancy should help to keep your pressure normal

> if you don't have any complications. I guess the

> hormones react to the aldosterone and lowers it. I

> had/have PA and my pressure was completely normal

> during pregnancy. 3 days after delivery each time it

> started to go back up. good luck.

> Off Spiro and blood

> pressure has remained low!

>

>

> I went off spironolactone on March 6 (to prep for

> getting pregnant and

> going onto a safe blood pressure med)and my bp has

> remained low ever

> since (~117/76). I saw my endocrinologist a

> week ago. She took at

> blood sample to test my K levels. If my potassium

> is ok, then she's

> going to test my renin and aldo levels.

>

> When I was originally diagnosed, my bp was as high

> as 150/115. My

> potassium levels were never very low, just

> slightly less than normal.

> My renin and aldosterone levels were off, but I

> don't remember the

> numbers. A MRI didn't show any tumors on either

> adrenal gland (now I

> know a CAT scan is better).

>

> I'd love to think that I healed myself, but I'm

> not sure what's going

> on. Let me know if you have any theories. I'll

> fill you in on the

> renin/aldosterone test when I get the results.

>

> Thanks,

>

>

>

>

>

>

>

------------------------------------------------------------------------------

>

[Guest guest]

Hi, Dr. Grim

This is interesting! I had high blood pressure with

my my second and latter pregnancy. With the last

child, it was quite high; in fact they took no-stress

tests every week to see if the baby was alright. At

the end of the pregnancy, I had pre-eclampsia; they

told me to get off my feet until the baby was born

(about six weeks). The baby had IUGR--intrauterine

growth retardation--caused by my high blood pressure.

They said if I had not gotten off my feet, my baby

would have weighed three pounds at birth. He had to

be induced.

I think my potassium may have slipped a bit, too, but

I do not have the records to substantiate this.

Would this same condition cause high blood pressure in

men in my family, or not? Just wondering if it is

worth pursuing.

Warmly,

Pam

--- lowerbp2@... wrote:

> PA gets better with Preg due to antagonistic effect

> of high progesterone.

> There is a rare genetic sydrome which causes HTN of

> preg in which the

> mineralocorticoid receptor has mutated so that

> progest occupies it and activates ENaC

> and HTN and low K results during pregnancy.

" I'd rather learn from one bird how to sing, than to teach ten thousand stars

how not to dance. "

__________________________________________________

[Guest guest]

Hi, Dr. Grim

I wonder if you could tell me if an incident like my

recent rise in blood pressure (to stroke level, after

approximately a year of being controlled on 100 mg

Spironolactone, and seeing my heart return to a normal

size and ejection fraction) is likely to be caused by

diet alone.

Could the evolution of PA be a factor? Would it be

worthwhile to have other testing done, and if so,

which tests would they be?

Thank you for your time and expertise!

Warmly,

Pam

--- lowerbp2@... wrote:

>

> In a message dated 4/30/05 5:40:24 AM,

> dave@... writes:

>

>

> > It can't, and that's one of my points.  Only in a

> post-op adrenalectomy

> > lab dissection.  Although on the CT, my right one

> looked normal in

> > every way except for a 1CM adenoma (which was

> found in the lab, gold in

> > color, the hallmark of PA, but not always) and 

> was distended to about

> > 50% bigger, with this CT-invisible diffuse mass. 

> Weighed more than

> > usual too.  Hyperplasia was caused, in this case,

> by a diffuse mass. 

> > The entire gland was enlarged, but not

> hyperplasic.  A large portion of

> > it was though, so functionally hyperplasic.  Now

> that I have had dex

> > suppression & genetic Yale test for GRA, and

> resistance to BP meds plus

> > 3 different 24-hour urines, it seems clear the

> left one is too,

> > although on CT it looks perfect.  So, I was BAH

> incorrectly diagnosed,

> > and they took out my right gland w/o AVS.

> >

>

> Review my evolution article and you will see the

> problem. Big adenomas come

> from small adenomas and these likely came from

> single cells that went haywire

> for an unknown reason and big hyperplasia comes from

> smaller hyperplasia etc.

>

>

> It is a continum than cannot be easily

> separated-indeed cannot be separated

> with current tests-ie where do you make the cut off?

>

> Thus my approach to give spiro or Inspra etc and

> only if BP cant be

> controlled or side effects are intolerable or K cant

> be controlled do I go to AVS.

>

>

>

>

>

> May your pressure be low!

>

> Clarence E. Grim, BS (Chem/Math), MS (Biochem), MD,

> FACP, FACC, FAHACHBPR

> Charter member of American Society of

> Hypertension(ASH) and the International

> Society for Hypertension in Blacks (ISHIB).

> Clinical Professor of Medicine and Epidemiology

> Director, Hypertension Diagnosis and Treatment

> Center

> Board Certified in Internal Medicine, Geriatrics and

> Hypertension

>

> Published over 220 scientific papers, book chapters

> and 220 abstracts

> in the area of high blood pressure epidemiology,

> physiology, endocrinology,

> measurement, treatment and how to detect curable

> causes.

> Listed in Best Doctors in America

> Specializing in Difficult to Control High Blood

> Pressure and the

> History and Physiology of High Blood pressure in the

> African Diaspora

> Member of the Board of Directors, ISHIB

>

>

" I'd rather learn from one bird how to sing, than to teach ten thousand stars

how not to dance. "

__________________________________________________

[Guest guest]

In a message dated 4/30/05 9:42:07 PM, leslie@... writes:

Would this same condition cause high blood pressure in

men in my family, or not?  Just wondering if it is

worth pursuing.

Warmly,

Pam

Depends on the type of PA you have. GRA is monogenic trait, autosomal dominant, such that, on the average, 50% of all blood relaties (mother, father, brothers, sisters and children) will be affected and same for anyone else in the family who is affected. Thus affected sibs will transmit this to their children 1/2 the time.

CE Grim, MD

[Guest guest]

In a message dated 4/30/05 4:28:47 PM, spirlhelix@... writes:

Hi, Dr. Grim

I wonder if you could tell me if an incident like my

recent rise in blood pressure (to stroke level, after

approximately a year of being controlled on 100 mg

Spironolactone, and seeing my heart return to a normal

size and ejection fraction) is likely to be caused by

diet alone.

Could the evolution of PA be a factor?  Would it be

worthwhile to have other testing done, and if so,

which tests would they be?

Thank you for your time and expertise!

Warmly,

Pam

My first suggestion is that you are out salting your spiro. Only way to tell is to have your Dr colect a 24 hr urine for sodium or try the 14 day DASH challenge diet and see what happens to your BP. This assumes that eating 1500 mg of sodium a day is a low enough amount for your HTN problem. Some may need 250 mg a day and for that you need to look at ricediet.com. Try the DASH first.

CE Grim, MD

[Guest guest]

In a message dated 4/30/05 9:50:35 PM, spirlhelix@... writes:

I can't quite picture how it might affect a man.

Not likely unless he gets a sec change and takes progesterone but I dont think many men who are brothers of those with the syndrome have been studied to know for certain.

CE Grim, MD

[Guest guest]

Here is some French data on PA that will be of interest.

J Am Coll Cardiol. 2005 Apr 19;45(8):1243-8. Related Articles,

CE Grim, MD

Links

 

Evidence for an increased rate of cardiovascular events in patients with primary aldosteronism.

Milliez P, Girerd X, Plouin PF, Blacher J, Safar ME, Mourad JJ.

Department of Cardiology, Lariboisiere Hospital, Paris, France.

OBJECTIVES: The aim of this report was to show that the rate of cardiovascular events is increased in patients with either subtype of primary aldosteronism (PA). BACKGROUND: Primary aldosteronism involves hypertension (HTN), hypokalemia, and low plasma renin. The two major PA subtypes are unilateral aldosterone-producing adenoma (APA) and bilateral adrenal hyperplasia. METHODS: During a three-year period, the diagnosis of PA was made in 124 of 5,500 patients referred for comprehensive evaluation and management. Adenomas were diagnosed in 65 patients and idiopathic hyperaldosteronism in 59 patients. During the same period, clinical characteristics and cardiovascular events of this group were compared with those of 465 patients with essential hypertension (EHT) randomly matched for age, gender, and systolic and diastolic blood pressure. RESULTS: A history of stroke was found in 12.9% of patients with PA and 3.4% of patients with EHT (odds ratio [OR] = 4.2; 95% confidence interval [CI] 2.0 to 8.6]). Non-fatal myocardial infarction was diagnosed in 4.0% of patients with PA and in 0.6% of patients with EHT (OR = 6.5; 95% CI 1.5 to 27.4). A history of atrial fibrillation was diagnosed in 7.3% of patients with PA and 0.6% of patients with EHT (OR = 12.1; 95% CI 3.2 to 45.2). The occurrence of cardiovascular complications was comparable in both subtypes of PA. CONCLUSIONS: Patients presenting with PA experienced more cardiovascular events than did EHT patients independent of blood pressure. The presence of PA should be detected, not only to determine the cause of HTN, but also to prevent such complications.

This last statement presumes that treating PA better will decresae the risk of CVD. We clearly need a trial to see if we can lower the risk to that seen in treated essential HTN.

This would involve recruitng say 3,000 pts with PA and 10,000 with essentails HTN that is not low renin. Controlling the BP to the same level and counting who gets into trouble earlier.

[Guest guest]

In a message dated 4/30/05 11:23:04 PM, farahbar@... writes:

How would one know if the have GRA? Is there a specific test for it? Is the treatment different?

Farah

genetic test or overnight dex suppression test first then trial of dex to see long term effect on aldo, bp and K.

The main clue is a family Hx of HTN and or low K and or strokes at an ealry age esp in men. I have seen HTN at age 10 from this.

CE Grim, MD

[Guest guest]

Pam, your pregnancy sounds almost identical to mine.... thanks for sharing the details.

Re: Off Spiro and blood pressure has remained low!

Hi, Dr. GrimThis is interesting! I had high blood pressure withmy my second and latter pregnancy. With the lastchild, it was quite high; in fact they took no-stresstests every week to see if the baby was alright. Atthe end of the pregnancy, I had pre-eclampsia; theytold me to get off my feet until the baby was born(about six weeks). The baby had IUGR--intrauterinegrowth retardation--caused by my high blood pressure. They said if I had not gotten off my feet, my babywould have weighed three pounds at birth. He had tobe induced.I think my potassium may have slipped a bit, too, butI do not have the records to substantiate this. Would this same condition cause high blood pressure inmen in my family, or not? Just wondering if it isworth pursuing.Warmly,Pam--- lowerbp2@... wrote:> PA gets better with Preg due to antagonistic effect> of high progesterone. > There is a rare genetic sydrome which causes HTN of> preg in which the > mineralocorticoid receptor has mutated so that> progest occupies it and activates ENaC > and HTN and low K results during pregnancy."I'd rather learn from one bird how to sing, than to teach ten thousand stars how not to dance."__________________________________________________

[Guest guest]

Hi, Dr. Grim

I was referring to the progesterone-sensitive

condition.

I can't quite picture how it might affect a man.

Warmly,

Pam

--- lowerbp2@... wrote:

>

> In a message dated 4/30/05 9:42:07 PM,

> leslie@... writes:

>

>

> > Would this same condition cause high blood

> pressure in

> > men in my family, or not?  Just wondering if it is

> > worth pursuing.

> >

> > Warmly,

> >

> > Pam

> >

> >

> >

>

> Depends on the type of PA you have. GRA is

> monogenic trait, autosomal

> dominant, such that, on the average, 50% of all

> blood relaties (mother, father,

> brothers, sisters and children) will be affected and

> same for anyone else in the

> family who is affected. Thus affected sibs will

> transmit this to their

> children 1/2 the time.

>

>

>

> CE Grim, MD

>

" I'd rather learn from one bird how to sing, than to teach ten thousand stars

how not to dance. "

__________________________________________________

[Guest guest]

Wow, great news--I had no idea. There are so few things DASH-er's can

eat or drink that taste good.

Dave

On Apr 30, 2005, at 8:33 AM, lowerbp2@... wrote:

>

> In a message dated 4/29/05 10:07:54 PM, dave@... writes:

>

>

>> Potasium, mine went down to 2.9 with them, and at one point, I was

>> > taking 20 MEQs to bring it backup to 3.5

>

>

> Just got some low Na V=8 that has 20 mEQs of K (640 mg) in it.  Tastes

> pretty good-like homemade tomato juice.

>

> CEG

>

>

>

> May your pressure be low!

>

> Clarence E. Grim, BS (Chem/Math), MS (Biochem), MD, FACP, FACC,

> FAHACHBPR

> Charter member of American Society of Hypertension(ASH) and the

> International Society for Hypertension in Blacks (ISHIB).

> Clinical Professor of Medicine and Epidemiology

> Director, Hypertension Diagnosis and Treatment Center

> Board Certified in Internal Medicine, Geriatrics and Hypertension

>

> Published over 220 scientific papers, book chapters and 220 abstracts

> in the area of high blood pressure epidemiology, physiology,

> endocrinology, measurement, treatment and how to detect curable

> causes.

> Listed in Best Doctors in America

> Specializing in Difficult to Control High Blood Pressure and the

> History and Physiology of High Blood pressure in the African Diaspora

> Member of the Board of Directors, ISHIB

>

>

[Guest guest]

How would one know if the have GRA? Is there a specific test for it? Is the treatment different?

FarahPamela s <spirlhelix@...> wrote:

Hi, Dr. GrimI wonder if you could tell me if an incident like myrecent rise in blood pressure (to stroke level, afterapproximately a year of being controlled on 100 mgSpironolactone, and seeing my heart return to a normalsize and ejection fraction) is likely to be caused bydiet alone.Could the evolution of PA be a factor? Would it beworthwhile to have other testing done, and if so,which tests would they be?Thank you for your time and expertise!Warmly,Pam--- lowerbp2@... wrote:> > In a message dated 4/30/05 5:40:24 AM,> dave@... writes:> > > > It can't, and that's one of my points. Only in a> post-op adrenalectomy> > lab dissection. Although on the CT, my right one> looked normal in> > every way except

for a 1CM adenoma (which was> found in the lab, gold in> > color, the hallmark of PA, but not always) and > was distended to about> > 50% bigger, with this CT-invisible diffuse mass. > Weighed more than> > usual too. Hyperplasia was caused, in this case,> by a diffuse mass. > > The entire gland was enlarged, but not> hyperplasic. A large portion of> > it was though, so functionally hyperplasic. Now> that I have had dex> > suppression & genetic Yale test for GRA, and> resistance to BP meds plus> > 3 different 24-hour urines, it seems clear the> left one is too,> > although on CT it looks perfect. So, I was BAH> incorrectly diagnosed,> > and they took out my right gland w/o AVS.> > > > Review my evolution article and you will see the> problem. Big adenomas come

> from small adenomas and these likely came from> single cells that went haywire > for an unknown reason and big hyperplasia comes from> smaller hyperplasia etc. > > > It is a continum than cannot be easily> separated-indeed cannot be separated > with current tests-ie where do you make the cut off?> > Thus my approach to give spiro or Inspra etc and> only if BP cant be > controlled or side effects are intolerable or K cant> be controlled do I go to AVS. > > > > > > May your pressure be low!> > Clarence E. Grim, BS (Chem/Math), MS (Biochem), MD,> FACP, FACC, FAHACHBPR> Charter member of American Society of> Hypertension(ASH) and the International > Society for Hypertension in Blacks (ISHIB).> Clinical Professor of Medicine and Epidemiology> Director, Hypertension Diagnosis and

Treatment> Center> Board Certified in Internal Medicine, Geriatrics and> Hypertension> > Published over 220 scientific papers, book chapters> and 220 abstracts> in the area of high blood pressure epidemiology,> physiology, endocrinology, > measurement, treatment and how to detect curable> causes.> Listed in Best Doctors in America> Specializing in Difficult to Control High Blood> Pressure and the> History and Physiology of High Blood pressure in the> African Diaspora> Member of the Board of Directors, ISHIB> > "I'd rather learn from one bird how to sing, than to teach ten thousand stars how not to dance."__________________________________________________

[Guest guest]

Hi, Dr. Grim

Thanks. I will try to get my doctor to do the 24-hour

urine. If I have been so entirely unsuccessful in my

efforts to maintain a low Na diet (I didn't think I

was doing that bad, although I was aware of a few

indiscretions), then I don't have much confidence that

I can maintain a strict DASH diet for two weeks.

I have high cholesterol, so I avoid fried foods. That

leaves me out of most fast food right there.

On a side note, in my experience it is possible to

have LVH and PA and not have coronary artery disease.

I have high cholesterol from liver and kidney

disorders (one time my triglycerides were listed as

579); when they did a cardiac catheterization, though,

my arteries were found to be perfectly clear.

Back to the subject--when I dine out, I most often

patronize restaurants unlikely to have lists of Na

content. In other words, I avoid fast food

restaurants and end up at family-owned places. My

usual strategy is to order all dressings, sauces, and

gravies " on the side " ; I also avoid breaded and fried

foods. It does not leave me much, but I can live with

it.

I'm just now starting to be cautious of the Na content

in breads and baked goods. I haven't come up with

alternatives for them yet, though. So that may be

something to work on to make progress toward the DASH

diet in the long run.

Warmly,

Pam

--- lowerbp2@... wrote:

>

> In a message dated 4/30/05 4:28:47 PM,

> spirlhelix@... writes:

>

>

> > Hi, Dr. Grim

> >

> > I wonder if you could tell me if an incident like

> my

> > recent rise in blood pressure (to stroke level,

> after

> > approximately a year of being controlled on 100 mg

> > Spironolactone, and seeing my heart return to a

> normal

> > size and ejection fraction) is likely to be caused

> by

> > diet alone.

> >

> > Could the evolution of PA be a factor?  Would it

> be

> > worthwhile to have other testing done, and if so,

> > which tests would they be?

> >

> > Thank you for your time and expertise!

> >

> > Warmly,

> >

> > Pam

> >

>

> My first suggestion is that you are out salting your

> spiro. Only way to

> tell is to have your Dr colect a 24 hr urine for

> sodium or try the 14 day DASH

> challenge diet and see what happens to your BP. This

> assumes that eating 1500 mg

> of sodium a day is a low enough amount for your HTN

> problem. Some may need

> 250 mg a day and for that you need to look at

> ricediet.com. Try the DASH

> first.

>

>

>

> CE Grim, MD

>

" I'd rather learn from one bird how to sing, than to teach ten thousand stars

how not to dance. "

__________________________________________________

[Guest guest]

In a message dated 5/1/05 8:23:04 AM, spirlhelix@... writes:

I'm just now starting to be cautious of the Na content

in breads and baked goods.  I haven't come up with

alternatives for them yet, though.  So that may be

something to work on to make progress toward the DASH

diet in the long run.  

The DASH book lists exactly what you need to eat for the 14 day challange diet so it should be easy. Read it and eat it. How hard can that be? Well not easy but think it as if you are playing the big game called you bet your life.

CE Grim, MD