Question about Inspra Dose and blood test results Renin, Aldosterone & Potassium

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I am currently taking 100 mg of Inspra

(eplerenone) in the morning and 100 mg of Inspra (eplerenone) at night with 5 mg of Norvasc (amlodipine) at night. I am also on the DASH diet. I am 30 pounds overweight BMI 30, 5'6" and 191 pounds.My recent test results as of April 2012 on Inspra without salt loading are Renin 0.29 and Aldosterone 93. My blood potassium is 3.9 and my urine potassium is 24.2My blood pressure is still an average of 140/90. Do you think it would lower my blood pressure if I took more Inspra such as 150 in the AM and 150 in the PM increasing my dose from 200 mg to 300 mg per day?Do you think it would be helpful and not dangerous to add Amiloride to the Inspra?Of course all this dosage changing would be under my doctor's advice and supervision. I just want to know if a larger dose of Inspra would be helpful in reducing my blood pressure to normal.If you have any experience with this or suggestions, recommendations or feedback, please reply.Thanks.

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Your urine K is per day or concentration. What was urine Na. They very low renin suggests eating a lot of salt as well. So first thing I would do DASH TO THE max with the 14 day plan in the book and see what happens. Check with your team. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn May 15, 2012, at 13:13, airlinerg <airlinerg@...> wrote:

I am currently taking 100 mg of Inspra

(eplerenone) in the morning and 100 mg of Inspra (eplerenone) at night with 5 mg of Norvasc (amlodipine) at night. I am also on the DASH diet. I am 30 pounds overweight BMI 30, 5'6" and 191 pounds.My recent test results as of April 2012 on Inspra without salt loading are Renin 0.29 and Aldosterone 93. My blood potassium is 3.9 and my urine potassium is 24.2My blood pressure is still an average of 140/90. Do you think it would lower my blood pressure if I took more Inspra such as 150 in the AM and 150 in the PM increasing my dose from 200 mg to 300 mg per day?Do you think it would be helpful and not dangerous to add Amiloride to the Inspra?Of course all this dosage changing would be under my doctor's advice and supervision. I just want to know if a larger dose of Inspra would be helpful in

reducing my blood pressure to normal.If you have any experience with this or suggestions, recommendations or feedback, please reply.Thanks.

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Dr. Grim, In answer to your questions about my 24 hour urine tests and blood tests on 4/4/12:24 hour urine tests: UrineVolume in 24 hours was 4514 ml. Sodium was 31 mmol/l and the mmol/24 hours was 140. (reference range 40-220)Potassium was 24.2 mmol/ and the mmol/24 hours was 109. (reference range 25-120)Creatinine was 37.4 mg/dl and 1,700 mg/24 hours (reference range 1,000 - 2,000)Microalbumin 1.8 mg/dl and 81.3 mg/24 hours (reference range 2-21)Urine free cortisol-ug was 8.5 ug/lUrine free cortisol was 38.4 ug/d (reference range is less than 60)Urine free cortisol-ug per gram was 12.69 ug/g (reference range is less than 32)_________________________________________________Blood tests:TSH 3.11 mcu/ml (reference range is 0.39-4.60)Aldosterone 93 ng/dl (reference range is less than 28)Plasma Renin 0.29 ng/ml/hr (reference range is 0.25-5.82)Potassium 3.9 mmol/l (reference range is (3.5-5.5)________________________________________________Dr. Grim, could you please answer these 4 questions?If I DASH and my blood pressure is still 140/90:1. If my plasma renin is 0.29 on my eplerenone dose of 100 mg twice a day, does that indicate I need to increase the eplerenone dose until my plasma renin level rises above 0.6 ?2. If I increase my eplerenone dose higher than 100 mg twice a day, how much should I increase it by?3. Do I need to add amiloride also at 5 mg. per day to start and increase up to 20 mg per day to lower my blood pressure in addition to increasing my eplerenone? (Of course I would do this after the increase in eplerenone alone fails to lower my blood pressure.)4. What does it mean if my 24 hour urine potassium and sodium results mean?Sodium was 31 mmol/l and the mmol/24 hours was 140. (reference range 40-220)Potassium was 24.2 mmol/ and the mmol/24 hours was 109. (reference range 25-120)Thanks> > > I am currently taking 100 mg of Inspra (eplerenone) in the morning and 100 mg of Inspra (eplerenone) at night with 5 mg of Norvasc (amlodipine) at night. I am also on the DASH diet. I am 30 pounds overweight BMI 30, 5'6" and 191 pounds.> > > > > > My recent test results as of April 2012 on Inspra without salt loading are Renin 0.29 and Aldosterone 93. My blood potassium is 3.9 and my urine potassium is 24.2> > > > My blood pressure is still an average of 140/90. > > > > Do you think it would lower my blood pressure if I took more Inspra such as 150 in the AM and 150 in the PM increasing my dose from 200 mg to 300 mg per day?> > > > Do you think it would be helpful and not dangerous to add Amiloride to the Inspra?> > > > Of course all this dosage changing would be under my doctor's advice and supervision. > > > > I just want to know if a larger dose of Inspra would be helpful in reducing my blood pressure to normal.> > > > If you have any experience with this or suggestions, recommendations or feedback, please reply.> > > > Thanks.> >>

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Excellent. The Na is too high for a good DASH and K is good. goal for DASH is about 70-80 in urine for Na. per day.On May 16, 2012, at 6:08 AM, airlinerg wrote: Dr. Grim, In answer to your questions about my 24 hour urine tests and blood tests on 4/4/12:24 hour urine tests: UrineVolume in 24 hours was 4514 ml. Sodium was 31 mmol/l and the mmol/24 hours was 140. (reference range 40-220)Potassium was 24.2 mmol/ and the mmol/24 hours was 109. (reference range 25-120)Creatinine was 37.4 mg/dl and 1,700 mg/24 hours (reference range 1,000 - 2,000)Microalbumin 1.8 mg/dl and 81.3 mg/24 hours (reference range 2-21)Urine free cortisol-ug was 8.5 ug/lUrine free cortisol was 38.4 ug/d (reference range is less than 60)Urine free cortisol-ug per gram was 12.69 ug/g (reference range is less than 32)_________________________________________________Blood tests:TSH 3.11 mcu/ml (reference range is 0.39-4.60)Aldosterone 93 ng/dl (reference range is less than 28)Plasma Renin 0.29 ng/ml/hr (reference range is 0.25-5.82)Potassium 3.9 mmol/l (reference range is (3.5-5.5)________________________________________________Dr. Grim, could you please answer these 4 questions?If I DASH and my blood pressure is still 140/90:1. If my plasma renin is 0.29 on my eplerenone dose of 100 mg twice a day, does that indicate I need to increase the eplerenone dose until my plasma renin level rises above 0.6 ?2. If I increase my eplerenone dose higher than 100 mg twice a day, how much should I increase it by?3. Do I need to add amiloride also at 5 mg. per day to start and increase up to 20 mg per day to lower my blood pressure in addition to increasing my eplerenone? (Of course I would do this after the increase in eplerenone alone fails to lower my blood pressure.)4. What does it mean if my 24 hour urine potassium and sodium results mean?Sodium was 31 mmol/l and the mmol/24 hours was 140. (reference range 40-220)Potassium was 24.2 mmol/ and the mmol/24 hours was 109. (reference range 25-120)Thanks> > > I am currently taking 100 mg of Inspra (eplerenone) in the morning and 100 mg of Inspra (eplerenone) at night with 5 mg of Norvasc (amlodipine) at night. I am also on the DASH diet. I am 30 pounds overweight BMI 30, 5'6" and 191 pounds.> > > > > > My recent test results as of April 2012 on Inspra without salt loading are Renin 0.29 and Aldosterone 93. My blood potassium is 3.9 and my urine potassium is 24.2> > > > My blood pressure is still an average of 140/90. > > > > Do you think it would lower my blood pressure if I took more Inspra such as 150 in the AM and 150 in the PM increasing my dose from 200 mg to 300 mg per day?> > > > Do you think it would be helpful and not dangerous to add Amiloride to the Inspra?> > > > Of course all this dosage changing would be under my doctor's advice and supervision. > > > > I just want to know if a larger dose of Inspra would be helpful in reducing my blood pressure to normal.> > > > If you have any experience with this or suggestions, recommendations or feedback, please reply.> > > > Thanks.> >>

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Would a higher dose of Inspra, for example 150 mg twice a day, help lower my blood pressure below 140/90 more than a dose of 100 mg of Inspra twice a day which is what I am currently taking? How can I know if I need a higher Inspra dose or not?

> > >> > > > I am currently taking 100 mg of Inspra (eplerenone) in the > > morning and 100 mg of Inspra (eplerenone) at night with 5 mg of > > Norvasc (amlodipine) at night. I am also on the DASH diet. I am 30 > > pounds overweight BMI 30, 5'6" and 191 pounds.> > > >> > > >> > > > My recent test results as of April 2012 on Inspra without salt > > loading are Renin 0.29 and Aldosterone 93. My blood potassium is 3.9 > > and my urine potassium is 24.2> > > >> > > > My blood pressure is still an average of 140/90.> > > >> > > > Do you think it would lower my blood pressure if I took more > > Inspra such as 150 in the AM and 150 in the PM increasing my dose > > from 200 mg to 300 mg per day?> > > >> > > > Do you think it would be helpful and not dangerous to add > > Amiloride to the Inspra?> > > >> > > > Of course all this dosage changing would be under my doctor's > > advice and supervision.> > > >> > > > I just want to know if a larger dose of Inspra would be helpful > > in reducing my blood pressure to normal.> > > >> > > > If you have any experience with this or suggestions, > > recommendations or feedback, please reply.> > > >> > > > Thanks.> > > >> > >> >> >>

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If 100 mg Inspra helps, then 150 mg may help more if you're not out-salting it. You monitor your blood pressure every day and see how you're doing. I keep a 7-day moving average to smooth up daily ups and downs. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of airlinerg Would a higher dose of Inspra, for example 150 mg twice a day, help lower my blood pressure below 140/90 more than a dose of 100 mg of Inspra twice a day which is what I am currently taking? How can I know if I need a higher Inspra dose or not?

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The only way to know is to try it.Can you add other meds to your thumbnail?CE Grim MDOn May 30, 2012, at 2:07 PM, airlinerg wrote: Would a higher dose of Inspra, for example 150 mg twice a day, help lower my blood pressure below 140/90 more than a dose of 100 mg of Inspra twice a day which is what I am currently taking? How can I know if I need a higher Inspra dose or not? > > >> > > > I am currently taking 100 mg of Inspra (eplerenone) in the > > morning and 100 mg of Inspra (eplerenone) at night with 5 mg of > > Norvasc (amlodipine) at night. I am also on the DASH diet. I am 30 > > pounds overweight BMI 30, 5'6" and 191 pounds.> > > >> > > >> > > > My recent test results as of April 2012 on Inspra without salt > > loading are Renin 0.29 and Aldosterone 93. My blood potassium is 3.9 > > and my urine potassium is 24.2> > > >> > > > My blood pressure is still an average of 140/90.> > > >> > > > Do you think it would lower my blood pressure if I took more > > Inspra such as 150 in the AM and 150 in the PM increasing my dose > > from 200 mg to 300 mg per day?> > > >> > > > Do you think it would be helpful and not dangerous to add > > Amiloride to the Inspra?> > > >> > > > Of course all this dosage changing would be under my doctor's > > advice and supervision.> > > >> > > > I just want to know if a larger dose of Inspra would be helpful > > in reducing my blood pressure to normal.> > > >> > > > If you have any experience with this or suggestions, > > recommendations or feedback, please reply.> > > >> > > > Thanks.> > > >> > >> >> >>