Re: Re: 39 yr old WM with HTN slightly low K and no adrenal mass

[Guest guest]

Different folks require different combos.CE Grim MDThanks for the information. I will have to track my blood pressure andheart rate at those time increments. I really do not want to be takingthis medicine anymore and am wondering why something so potentiallydangerous was even prescribed to me. This med seems like it should be alast resort for someone with extremely high BP. Mine was high, but neverextremely high.polymac>> >> > Dr. Grim,> >> > I would like to thank you for your advise previously to discuss with> > my> > doctor that atenolol does not work in PA and to discussdiscontinuing> > it. I have phased it out over the past month and on Sundaycompletely> > eliminated it. I am happy to report that my blood pressure remains> > essentially unchanged and I feel almost normal. I have a lot more> > enery> > and have been able to start exercising again. I acutally even feel> > good> > after excercise. Before, I justed to feel sick and exhausted.> > However, I> > have a question regarding increased heart rate. Since I stoppedtaking> > the atenolol, my heart rate has increased from about 70 to 90. Is> > this a> > normal part of my body adjusting to not having the atenolol? It isnot> > anything that is causing me any discomfort or anything. I am just> > curious. Below are my current meds.> >> > 50 mg Spiro 2X/day> >> > 0.2 mg Clonidine at bedtime> >> > Thanks,> >> > polymac> >> >> >>

[Guest guest]

Good, Dr. Grim,I will still also track my pulse as you suggested, but I also have somereadings I have taken over the past couple of days at different timesduring the day. Keep in mind that these are readings in time order, butfrom the past couple of days.Took Clonidine at approx 11:00pm12:00 am pulse = 85 bpm 147/861:35 am pulse = 80 bpm 113/718:15 am pulse = 83 bpm 131/812:20pm pulse = 94 bpm 141/774:45 pm pulse = 92 bpm 130/82From the above data, it looks like my pulse drops a couple of hoursafter taking the clonidine and then increases by early afternoon andcontinues to stay elevated until I take the next dosage of clonidine. Isthis something that is dangerous? I do plan to talk to my doctor aboutstopping this medicine. I want to make sure that he does not try toattribute this to stopping my atenolol. I will collect the data youindicated previously and post once I have it.polymac> >> > >> > > Dr. Grim,> > >> > > I would like to thank you for your advise previously to discusswith> > > my> > > doctor that atenolol does not work in PA and to discuss> discontinuing> > > it. I have phased it out over the past month and on Sunday> completely> > > eliminated it. I am happy to report that my blood pressure remains> > > essentially unchanged and I feel almost normal. I have a lot more> > > enery> > > and have been able to start exercising again. I acutally even feel> > > good> > > after excercise. Before, I justed to feel sick and exhausted.> > > However, I> > > have a question regarding increased heart rate. Since I stopped> taking> > > the atenolol, my heart rate has increased from about 70 to 90. Is> > > this a> > > normal part of my body adjusting to not having the atenolol? It is> not> > > anything that is causing me any discomfort or anything. I am just> > > curious. Below are my current meds.> > >> > > 50 mg Spiro 2X/day> > >> > > 0.2 mg Clonidine at bedtime> > >> > > Thanks,> > >> > > polymac> > >> > >> > >> >>

[Guest guest]

Trust you are taking 3 reading BP and pulse at each reading and sending averages.sorry to interfer in the chat, but it is normal that your pulse go down at night, specially if you are in bed or resting.When I just wake up my pulse is 40-50bpm and during the day it increases till 100, then when I go to bed it goes to 40-50againhowever a change of 3bpm is nothing even 10bpm is nothing just by standing up your BPM will change.however you stopped atenolol so your HR will go up for sometime...then again you can clearly see the effect of the clonidine when your bp is at 115/70 then it kinda rises until at the end of the day you are around 150/90.just my 0002cents.> > >> > > >> > > > Dr. Grim,> > > >> > > > I would like to thank you for your advise previously to discuss> with> > > > my> > > > doctor that atenolol does not work in PA and to discuss> > discontinuing> > > > it. I have phased it out over the past month and on Sunday> > completely> > > > eliminated it. I am happy to report that my blood pressure remains> > > > essentially unchanged and I feel almost normal. I have a lot more> > > > enery> > > > and have been able to start exercising again. I acutally even feel> > > > good> > > > after excercise. Before, I justed to feel sick and exhausted.> > > > However, I> > > > have a question regarding increased heart rate. Since I stopped> > taking> > > > the atenolol, my heart rate has increased from about 70 to 90. Is> > > > this a> > > > normal part of my body adjusting to not having the atenolol? It is> > not> > > > anything that is causing me any discomfort or anything. I am just> > > > curious. Below are my current meds.> > > >> > > > 50 mg Spiro 2X/day> > > >> > > > 0.2 mg Clonidine at bedtime> > > >> > > > Thanks,> > > >> > > > polymac> > > >> > > >> > > >> > >> >>

[Guest guest]

My doc says high pulse is due to my weight bmi> 25

|

|

|That's true, but my main concern is that my resting pulse was

|very high for me (90-94) for just sitting at home not doing

|anything. Even before all of the blood pressure meds, this

|would not be normal for me.

[Guest guest]

Were u or machine counting pulSe? Some machines not so good. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

That's true, but my main concern is that my resting pulse was very high

for me (90-94) for just sitting at home not doing anything. Even before

all of the blood pressure meds, this would not be normal for me.

> > > >

> > > > >

> > > > > Dr. Grim,

> > > > >

> > > > > I would like to thank you for your advise previously to

discuss

> > with

> > > > > my

> > > > > doctor that atenolol does not work in PA and to discuss

> > > discontinuing

> > > > > it. I have phased it out over the past month and on Sunday

> > > completely

> > > > > eliminated it. I am happy to report that my blood pressure

remains

> > > > > essentially unchanged and I feel almost normal. I have a lot

more

> > > > > enery

> > > > > and have been able to start exercising again. I acutally even

feel

> > > > > good

> > > > > after excercise. Before, I justed to feel sick and exhausted.

> > > > > However, I

> > > > > have a question regarding increased heart rate. Since I

stopped

> > > taking

> > > > > the atenolol, my heart rate has increased from about 70 to 90.

Is

> > > > > this a

> > > > > normal part of my body adjusting to not having the atenolol?

It is

> > > not

> > > > > anything that is causing me any discomfort or anything. I am

just

> > > > > curious. Below are my current meds.

> > > > >

> > > > > 50 mg Spiro 2X/day

> > > > >

> > > > > 0.2 mg Clonidine at bedtime

> > > > >

> > > > > Thanks,

> > > > >

> > > > > polymac

> > > > >

> > > > >

> > > > >

> > > >

> > >

> >

>

[Guest guest]

And the data is?My doc says high pulse is due to my weight bmi> 25|||That's true, but my main concern is that my resting pulse was |very high for me (90-94) for just sitting at home not doing |anything. Even before all of the blood pressure meds, this |would not be normal for me.

[Guest guest]

check it you self at home as well. count for 60 sec. CE Grim MDPulse measurement is from my blood pressure cuff. I think it is prettyaccurate. It is consistent with other manual pulse checks I have had atthe doctor's office.Polymac> > > > > >> > > > > > >> > > > > > > Dr. Grim,> > > > > > >> > > > > > > I would like to thank you for your advise previously to> > discuss> > > > with> > > > > > > my> > > > > > > doctor that atenolol does not work in PA and to discuss> > > > > discontinuing> > > > > > > it. I have phased it out over the past month and on Sunday> > > > > completely> > > > > > > eliminated it. I am happy to report that my blood pressure> > remains> > > > > > > essentially unchanged and I feel almost normal. I have alot> > more> > > > > > > enery> > > > > > > and have been able to start exercising again. I acutallyeven> > feel> > > > > > > good> > > > > > > after excercise. Before, I justed to feel sick andexhausted.> > > > > > > However, I> > > > > > > have a question regarding increased heart rate. Since I> > stopped> > > > > taking> > > > > > > the atenolol, my heart rate has increased from about 70 to90.> > Is> > > > > > > this a> > > > > > > normal part of my body adjusting to not having theatenolol?> > It is> > > > > not> > > > > > > anything that is causing me any discomfort or anything. Iam> > just> > > > > > > curious. Below are my current meds.> > > > > > >> > > > > > > 50 mg Spiro 2X/day> > > > > > >> > > > > > > 0.2 mg Clonidine at bedtime> > > > > > >> > > > > > > Thanks,> > > > > > >> > > > > > > polymac> > > > > > >> > > > > > >> > > > > > >> > > > > >> > > > >> > > >> > >> >> >>

[Guest guest]

My daily bp & medication doses & conditions records since 1999 for my statistical analysis are now compressed into about 9 MB binary and increasing!...in text format they are much larger. One sample is:

Max.

And the data is?

My doc says high pulse is due to my weight bmi> 25|||That's true, but my main concern is that my resting pulse was |very high for me (90-94) for just sitting at home not doing |anything. Even before all of the blood pressure meds, this |would not be normal for me.

[Guest guest]

This is excellent. Can we do an iPhone/Pad app using K, BP and meds as wellRecall there are 70 million with HTN. WE can only change $1. CE Grim MDMy daily bp & medication doses & conditions records since 1999 for my statistical analysis are now compressed into about 9 MB binary and increasing!...in text format they are much larger. One sample is: Max.And the data is?My doc says high pulse is due to my weight bmi> 25|||That's true, but my main concern is that my resting pulse was |very high for me (90-94) for just sitting at home not doing |anything. Even before all of the blood pressure meds, this |would not be normal for me.

[Guest guest]

And here is my Systolic BP since 1999 and 75 drug combos:

This is excellent. Can we do an iPhone/Pad app using K, BP and meds as well

Recall there are 70 million with HTN.

WE can only change $1.

CE Grim MD

[Guest guest]

This is excellent. Can drugs be indicated on the x axis somehow?I am serious about an iPhone app. There is nothing like this out there. Another plot would be E Na and EK over time on Na intake and K intake overtime. I think we need to talk.CE Grim MDAnd here is my Systolic BP since 1999 and 75 drug combos: This is excellent. Can we do an iPhone/Pad app using K, BP and meds as wellRecall there are 70 million with HTN. WE can only change $1. CE Grim MD

[Guest guest]

Tests: Serum K, Na

Medications: Spiro, K.Cl, K.Citr (other meds not included)

NB.: Vertical axis is Log scale.

Max.

This is excellent. Can drugs be indicated on the x axis somehow?

I am serious about an iPhone app. There is nothing like this out there.

Another plot would be E Na and EK over time on Na intake and K intake overtime.

I think we need to talk.

CE Grim MD

[Guest guest]

Thank you. Very helpful. Can you also give us those 75 combos with dosage. And how did you calculate mean -based on how many tests and for how long -one day, 100 days?To: hyperaldosteronism Sent: Fri, February 4, 2011 7:56:03 PMSubject: RE: Re: 39 yr old WM with HTN slightly low K and no adrenal mass

And here is my Systolic BP since 1999 and 75 drug combos:

This is excellent. Can we do an iPhone/Pad app using K, BP and meds as well

Recall there are 70 million with HTN.

WE can only change $1.

CE Grim MD

[Guest guest]

Mean values are average of sbp random readings during the period of dose combos...each combo period varies from few days to about 3.5 years.

See other chart on my Spiro, K, Na,...for the period I started Spiro=100mg/d...until then no matter which medication combo I used my bp never was under control, i.e., steady during the day and during the combo period. So I wish to place emphasize on Spiro doses in my PA L adenoma condition.

Max.

61M L adenoma NP59 Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Prav=40, Feno=67, K.cl=120 mEq

Thank you. Very helpful. Can you also give us those 75 combos with dosage. And how did you calculate mean -based on how many tests and for how long -one day, 100 days?

To: hyperaldosteronism Sent: Fri, February 4, 2011 7:56:03 PMSubject: RE: Re: 39 yr old WM with HTN slightly low K and no adrenal mass

And here is my Systolic BP since 1999 and 75 drug combos:

This is excellent. Can we do an iPhone/Pad app using K, BP and meds as well

Recall there are 70 million with HTN.

WE can only change $1.

CE Grim MD

[Guest guest]

Not sure what one would do with the 75 combo list.The number of possible BP combinations is in the millions now. I used to have a slide I used when there were no ACES or ARBS and it was in the 100 of thousands then. Maybe some one can update the calculation which went something like this as I recall.single drugs say 100Classes of drugs: diureteics (n=xx), alpha blockers (n = xx) etc, beta blockers, calcium channel blockers. ACEs, ARBs, MCBs, vasodilators, centrally acting agents, K Sympathetic blockers renin inhibitors. Then add combosSo you want to calculate the numbers of combinations and permutations for 2 diff drugs, 3, 4 , 5 , 6 etc. Few will take 6 groups. Good science project. I used to use the slide to point out that a hypertensionologist is like a dermatologist: We never cure and will always have another combo to try.CE Grim MDThank you. Very helpful. Can you also give us those 75 combos with dosage. And how did you calculate mean -based on how many tests and for how long -one day, 100 days?To: hyperaldosteronism Sent: Fri, February 4, 2011 7:56:03 PMSubject: RE: Re: 39 yr old WM with HTN slightly low K and no adrenal mass And here is my Systolic BP since 1999 and 75 drug combos: This is excellent. Can we do an iPhone/Pad app using K, BP and meds as wellRecall there are 70 million with HTN. WE can only change $1. CE Grim MD

[Guest guest]

MaxNice plots but are you still on all the meds you list in your thumbsketch? That is a ton of K and suspect you must be eating a lot of Na to require this much on spiro.Again I think if we could put this in an iPhone app we might be able to retire. CE Grim MDMean values are average of sbp random readings during the period of dose combos...each combo period varies from few days to about 3.5 years. See other chart on my Spiro, K, Na,...for the period I started Spiro=100mg/d...until then no matter which medication combo I used my bp never was under control, i.e., steady during the day and during the combo period. So I wish to place emphasize on Spiro doses in my PA L adenoma condition. Max. 61M L adenoma NP59 Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Prav=40, Feno=67, K.cl=120 mEqThank you. Very helpful. Can you also give us those 75 combos with dosage. And how did you calculate mean -based on how many tests and for how long -one day, 100 days?To: hyperaldosteronism Sent: Fri, February 4, 2011 7:56:03 PMSubject: RE: Re: 39 yr old WM with HTN slightly low K and no adrenal mass And here is my Systolic BP since 1999 and 75 drug combos: This is excellent. Can we do an iPhone/Pad app using K, BP and meds as wellRecall there are 70 million with HTN. WE can only change $1. CE Grim MD

[Guest guest]

I would like all to note Max's one line mini Hx that helps me keep him separate from the other 500 + we have on our site.CE Grim MDMean values are average of sbp random readings during the period of dose combos...each combo period varies from few days to about 3.5 years. See other chart on my Spiro, K, Na,...for the period I started Spiro=100mg/d...until then no matter which medication combo I used my bp never was under control, i.e., steady during the day and during the combo period. So I wish to place emphasize on Spiro doses in my PA L adenoma condition. Max. 61M L adenoma NP59 Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Prav=40, Feno=67, K.cl=120 mEqThank you. Very helpful. Can you also give us those 75 combos with dosage. And how did you calculate mean -based on how many tests and for how long -one day, 100 days?To: hyperaldosteronism Sent: Fri, February 4, 2011 7:56:03 PMSubject: RE: Re: 39 yr old WM with HTN slightly low K and no adrenal mass And here is my Systolic BP since 1999 and 75 drug combos: This is excellent. Can we do an iPhone/Pad app using K, BP and meds as wellRecall there are 70 million with HTN. WE can only change $1. CE Grim MD

[Guest guest]

Would be good to plot spiro (x) and p[K] y and BP y on one graph. ONly need systolic BP.CEMean values are average of sbp random readings during the period of dose combos...each combo period varies from few days to about 3.5 years. See other chart on my Spiro, K, Na,...for the period I started Spiro=100mg/d...until then no matter which medication combo I used my bp never was under control, i.e., steady during the day and during the combo period. So I wish to place emphasize on Spiro doses in my PA L adenoma condition. Max. 61M L adenoma NP59 Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Prav=40, Feno=67, K.cl=120 mEqThank you. Very helpful. Can you also give us those 75 combos with dosage. And how did you calculate mean -based on how many tests and for how long -one day, 100 days?To: hyperaldosteronism Sent: Fri, February 4, 2011 7:56:03 PMSubject: RE: Re: 39 yr old WM with HTN slightly low K and no adrenal mass And here is my Systolic BP since 1999 and 75 drug combos: This is excellent. Can we do an iPhone/Pad app using K, BP and meds as wellRecall there are 70 million with HTN. WE can only change $1. CE Grim MD

[Guest guest]

When doses of actual drugs are available, analysis is more accurate using those rather than n=xx diuretics, BB, ACs, A2RBs, etc... but in an analysis in which data from many patients are combined they would certainly be helpful specially when some patients' have missing drug doses.

Max.

61M L adenoma NP59 Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Prav=40, Feno=67, K.cl=120 mEq

Not sure what one would do with the 75 combo list.

The number of possible BP combinations is in the millions now. I used to have a slide I used when there were no ACES or ARBS and it was in the 100 of thousands then.

Maybe some one can update the calculation which went something like this as I recall.

single drugs say 100

Classes of drugs: diureteics (n=xx), alpha blockers (n = xx) etc, beta blockers, calcium channel blockers. ACEs, ARBs, MCBs, vasodilators, centrally acting agents, K Sympathetic blockers renin inhibitors. Then add combos

So you want to calculate the numbers of combinations and permutations for 2 diff drugs, 3, 4 , 5 , 6 etc. Few will take 6 groups.

Good science project.

I used to use the slide to point out that a hypertensionologist is like a dermatologist: We never cure and will always have another combo to try.

CE Grim MD

Thank you. Very helpful. Can you also give us those 75 combos with dosage. And how did you calculate mean -based on how many tests and for how long -one day, 100 days?

To: hyperaldosteronism Sent: Fri, February 4, 2011 7:56:03 PMSubject: RE: Re: 39 yr old WM with HTN slightly low K and no adrenal mass

And here is my Systolic BP since 1999 and 75 drug combos:

[Guest guest]

Yes, I am still on 8 drugs. I discussed with my doc your proposal to eliminate Amlo+Ram+Indap plus my breast pain and he decided to keep me as it is saying that if he eliminates the 3 drugs he has to increase Spiro from 100 to >100 and I get further breast pain. Switching to Inspra also seems super difficult for now. But my bp is so steady and controlled that I am considering to stay on them instead of adrenalectomy for now.

Max.

61M L adenoma NP59 Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Prav=40, Feno=67, K.cl=120 mEq

Max

Nice plots but are you still on all the meds you list in your thumbsketch? That is a ton of K and suspect you must be eating a lot of Na to require this much on spiro.

Again I think if we could put this in an iPhone app we might be able to retire.

CE Grim MD

[Guest guest]

Here is what I would do. 24 hr urine for Na and K and creat. If ENa is not less than EK THEN u are not dashing to the Max. But I recall you are taking a ton of K So if ENa is not less than 70 mM u are not maxed out. To minimize need for Spiro you could also try the rice diet which is 250 mg Na. I would also step down the other drugs that don't work in PA and see what Bp does. What is problem changing to eplerenone? It would likely get u off all other BP drugs AND K pills but what do I know. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

Yes, I am still on 8 drugs. I discussed with my doc your proposal to eliminate Amlo+Ram+Indap plus my breast pain and he decided to keep me as it is saying that if he eliminates the 3 drugs he has to increase Spiro from 100 to >100 and I get further breast pain. Switching to Inspra also seems super difficult for now. But my bp is so steady and controlled that I am considering to stay on them instead of adrenalectomy for now.

Max.

61M L adenoma NP59 Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Prav=40, Feno=67, K.cl=120 mEq

Max

Nice plots but are you still on all the meds you list in your thumbsketch? That is a ton of K and suspect you must be eating a lot of Na to require this much on spiro.

Again I think if we could put this in an iPhone app we might be able to retire.

CE Grim MD

[Guest guest]

You missed my point I was inviting someone to calculate how many possible combinations of Bp meds there are today. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

When doses of actual drugs are available, analysis is more accurate using those rather than n=xx diuretics, BB, ACs, A2RBs, etc... but in an analysis in which data from many patients are combined they would certainly be helpful specially when some patients' have missing drug doses.

Max.

61M L adenoma NP59 Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Prav=40, Feno=67, K.cl=120 mEq

Not sure what one would do with the 75 combo list.

The number of possible BP combinations is in the millions now. I used to have a slide I used when there were no ACES or ARBS and it was in the 100 of thousands then.

Maybe some one can update the calculation which went something like this as I recall.

single drugs say 100

Classes of drugs: diureteics (n=xx), alpha blockers (n = xx) etc, beta blockers, calcium channel blockers. ACEs, ARBs, MCBs, vasodilators, centrally acting agents, K Sympathetic blockers renin inhibitors. Then add combos

So you want to calculate the numbers of combinations and permutations for 2 diff drugs, 3, 4 , 5 , 6 etc. Few will take 6 groups.

Good science project.

I used to use the slide to point out that a hypertensionologist is like a dermatologist: We never cure and will always have another combo to try.

CE Grim MD

Thank you. Very helpful. Can you also give us those 75 combos with dosage. And how did you calculate mean -based on how many tests and for how long -one day, 100 days?

To: hyperaldosteronism Sent: Fri, February 4, 2011 7:56:03 PMSubject: RE: Re: 39 yr old WM with HTN slightly low K and no adrenal mass

And here is my Systolic BP since 1999 and 75 drug combos:

[Guest guest]

I take < 1999.99 mg/d salt. Am I losing K in urine because of Indapamide=2.5?

DASHing I can do if it means: just eat what you find in the kitchen!

Max.

61M L adenoma NP59 Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Prav=40, Feno=67, K.cl=120 mEq

Here is what I would do.

24 hr urine for Na and K and creat.

If ENa is not less than EK THEN u are not dashing to the Max. But I recall you are taking a ton of K

So if ENa is not less than 70 mM u are not maxed out. To minimize need for Spiro you could also try the rice diet which is 250 mg Na.

I would also step down the other drugs that don't work in PA and see what Bp does. What is problem changing to eplerenone? It would likely get u off all other BP drugs AND K pills but what do I know. Tiped sad Send form mi

iPhone ;-)

May your pressure be low!

CE Grim MD

Specializing in Difficult

Hypertension

Yes, I am still on 8 drugs. I discussed with my doc your proposal to eliminate Amlo+Ram+Indap plus my breast pain and he decided to keep me as it is saying that if he eliminates the 3 drugs he has to increase Spiro from 100 to >100 and I get further breast pain. Switching to Inspra also seems super difficult for now. But my bp is so steady and controlled that I am considering to stay on them instead of adrenalectomy for now.

Max.

61M L adenoma NP59 Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Prav=40, Feno=67, K.cl=120 mEq

Max

Nice plots but are you still on all the meds you list in your thumbsketch? That is a ton of K and suspect you must be eating a lot of Na to require this much on spiro.

Again I think if we could put this in an iPhone app we might be able to retire.

CE Grim MD

[Guest guest]

Indap is supposed to be K sparing. Recall lower Na in diet means less K in urine. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

I take < 1999.99 mg/d salt. Am I losing K in urine because of Indapamide=2.5?

DASHing I can do if it means: just eat what you find in the kitchen!

Max.

61M L adenoma NP59 Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Prav=40, Feno=67, K.cl=120 mEq

Here is what I would do.

24 hr urine for Na and K and creat.

If ENa is not less than EK THEN u are not dashing to the Max. But I recall you are taking a ton of K

So if ENa is not less than 70 mM u are not maxed out. To minimize need for Spiro you could also try the rice diet which is 250 mg Na.

I would also step down the other drugs that don't work in PA and see what Bp does. What is problem changing to eplerenone? It would likely get u off all other BP drugs AND K pills but what do I know. Tiped sad Send form mi

iPhone ;-)

May your pressure be low!

CE Grim MD

Specializing in Difficult

Hypertension

Yes, I am still on 8 drugs. I discussed with my doc your proposal to eliminate Amlo+Ram+Indap plus my breast pain and he decided to keep me as it is saying that if he eliminates the 3 drugs he has to increase Spiro from 100 to >100 and I get further breast pain. Switching to Inspra also seems super difficult for now. But my bp is so steady and controlled that I am considering to stay on them instead of adrenalectomy for now.

Max.

61M L adenoma NP59 Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Prav=40, Feno=67, K.cl=120 mEq

Max

Nice plots but are you still on all the meds you list in your thumbsketch? That is a ton of K and suspect you must be eating a lot of Na to require this much on spiro.

Again I think if we could put this in an iPhone app we might be able to retire.

CE Grim MD

[Guest guest]

Did you try to play with spiro dosage? I am asking that because I have a strange effect. I was on Micardis 160 mg a day, when I started 50 mg a day of eplerenone and took it for three weeks. During my visit to my Doc my BP was 155/85 and he recommended to make eplerenone 100 mg (twice more) and Micardis 80 mg (50% off). I had it done and my BP became steadily higher. I got back to 160 Micardis and kept 100 of eplerenone. Still high BP. I got back to original dosage 50 + 80. My BP is much better, but I still got almost all symptoms of PA that I didn't have on 100 eplerenone. Is it possible that lower dosage works better for BP than higher?Many, many thanks.To: hyperaldosteronism Sent: Sat, February 5, 2011 11:16:34 AMSubject: RE: Re: 39 yr old WM with HTN slightly low K and no adrenal mass

Mean values are average of sbp random readings during the period of dose combos...each combo period varies from few days to about 3.5 years.

See other chart on my Spiro, K, Na,...for the period I started Spiro=100mg/d...until then no matter which medication combo I used my bp never was under control, i.e., steady during the day and during the combo period. So I wish to place emphasize on Spiro doses in my PA L adenoma condition.

Max.

61M L adenoma NP59 Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Prav=40, Feno=67, K.cl=120 mEq

Thank you. Very helpful. Can you also give us those 75 combos with dosage. And how did you calculate mean -based on how many tests and for how long -one day, 100 days?

To: hyperaldosteronism Sent: Fri, February 4, 2011 7:56:03 PMSubject: RE: Re: 39 yr old WM with HTN slightly low K and no adrenal mass

And here is my Systolic BP since 1999 and 75 drug combos:

This is excellent. Can we do an iPhone/Pad app using K, BP and meds as well

Recall there are 70 million with HTN.

WE can only change $1.

CE Grim MD