Re: Update after increasing Inspra

[Guest guest]

Nothing wrong with working up to the correct dose slowly-usually.Glad he is doing so well.Can you give us a DASH success story when you have time?Be sure to let your specialist know the key role DASHing is playing as well. Most have never used it in PA.Would be interested if he does use it routinely?Have you filled out his data in our database? If you have done it before it might be good to update it.See 8 below.Trust you have taken my article to all who missed him for the last 5+ years so they will not miss the others they are taking care of. Welcome to the exciting world of Hyperaldosteronism! You are in the right place! I am Dr. CE Grim a retired Professor of Medicine and Endocrinology. I have a long standing interest is Primary Aldosteronism since medical school days when I saw my first patient with Primary Aldosteronism in 1963. I trained with Dr. Jerome W. Conn in Endocrinology and Metabolism 1969-70 and have published over 240 papers and book chapters in most areas of the discipline of High Blood Pressure. My CV is in our files for details. The goal of our group is to teach you and your health care team about the ins and outs of the causes, diagnosis and control of the many forms of hyperaldosteronism. The steps below will introduce you into the fascinating world of high blood pressure, salt (sodium(Na) chloride (Cl) or NaCL) and potassium (K) and the role of the adrenal hormone aldosterone in health and disease. Doing these in sequence will save you time and effort in getting up to speed in taking control of you health and educating your own health care team. While we can’t make you into a doctor we will make you into a pretty good BP doctor-a skill that you will have for life and you can transfer to the rest of your family who will likely have high blood pressure eventually-if they live long enough. 1. A brief history of Primary Aldosteronsim and why it is so common today in drug resistant high blood pressure. Read my article in our files on the evolution of PA (Evolution_of_PA-Grim.pdf ) and take to all members of health care team. Tell us what stage you believe you are in. This is a brief review of most causes of hyperaldosteronism, high blood pressure, low potassium (K). READING THIS WILL SAVE YOU TIME AND MONEY. By taking it to your health care team they will not treat their other patients in the future as badly as they may have treated you in the past. You can also read and take the url to your health care team link: http://www.endotext.org/protocols/protocols7/protocolsframe7.htmThis is from a leading Endocrine text book they may have not read recently. 2. Read about other patients with hyperaldosteronism (Conn’s syndrome). Read our Conn's stories in our files and then give us your own in as much detail as you can. Dr. Conn was the first to describe this disease process and the syndrome is named after him. The first patient is described in my review article.To see others' stories, on the Hyperaldosteronism home page, go to Files/Conn’s Stories. You'll find instructions in "A - How to put your story here.doc " First send us your story in an email and they we may have questions and suggestions before you upload it to our files. 3. DASH to lower your BP. Your and my tax dollars funded the most important series of studies on how to improve blood pressure, blood sugar, blood lipids and make your heart smaller: The DASH Eating Plan to control high blood pressure due to hyperaldosteronism and most others with high blood pressure. This will reduce your need for medications and in many will get your BP and K to goal without meds.. Get the DASH diet book by T. et al, (http://www.amazon.com/DASH-Diet-Hypertension--/dp/0743202953) read it and use it: ~$8 in paperback at your local bookstore or online. If they don’t have it ask them to order it for you. You can also get the hardback larger print version as well at Amazon. Learning to eat the DASH way will play a major role in your road to good BP and K control and, in many of our folks here, will revolutionize your life. See http://en.wikipedia.org/wiki/DASH_diet for an overview and more details. In the book go to chapter 9 and do the 14 day challenge. Tell your Dr you are doing this as your BP may plummet if you are on other meds. Measure your BP every day and post to us. or go to http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf download this 64 page booklet free and do the Week on the DASH Diet for 2 weeks. If you are on BP meds be prepared for a large fall in BP (20/10 mm Hg or more) and let your Dr. know you are doing this. And/Or go to (but costs money monthly) DASH Diet for Health Program (http://www.dashforhealth.com/pages/public/tour.php)The DASH Diet for Health Program is designed to help you improve your eating and exercise habits. Twice each week they will provide you with information on our website about food, food preparation, eating out, losing weight, getting fit and much more. In addition to providing new information each week on the website, they create a web page specially for you where you can track progress in areas such as your weight, blood pressure, and exercise. I strongly recommend you get this book by .... and read it. 4. Measure your BP: Measure your BP daily so you can see if it is getting better. If you are taking meds be sure to tell your health care team you are doing this as your BP may plummet to normal quickly. We recommend you use a device you listen to and will help you learn how to do this. If this is not something you want to do we can teach a significant other how to do it. See sharedcareinc.com or email to sharedcare@... to order a video on how to do this. If you already have one we will teach you how to teach your health care team how to validate your device. Your life and health depends on accurate BP measurements. Go to the amricanheart.org and download the Guidelines for Human Blood Pressure Measurement. Insist that your health care team do BP the AHA way. Never trust your life to an automatic BP machine unless you know it is accurate on YOU. 5. Genetics and your BP: If you have a twin be sure to let us know. Go to familyhistory.hhs.gov and do your detailed family medical history (FHx or FH) so we can review with you to help diagnosis (Dx) and treat (Rx) familial causes of high blood pressure and heart disease. If BP runs in your family you may save lives in your family by checking their BP yourself. 6. How to DX and treat PA: Go to our file/Conn's Articles of Note/Medications/Bravo spir 1973.pdf and read this article and take to your health care team. It is old but still one of the best in the medical management of PA. Note one with PA whose BP and K normalized with low Na, High K diet and only 25 mg of spiro. DX: Also see our file from the Endocrine Society Guidelines on PA. 7. Dr. Grim's Perfect Primary Aldosteronism Blood and Urine Testing to diagnose PA in one day. 1. Eat a regular to high salt diet for 2 weeks.2. No BP meds in last 4-12 weeks depending on meds.3. Collect 24 hr urine for Na, K and creatinine and aldosterone. Do not lose a drop of this liquid gold. It is impossible to interpret the renin and aldo without this.4. The morning you finish the 24 hr urine have fasting blood drawn for renin, aldo and K using our guidelines to get an accurate K (http://groups.yahoo.com/group/hyperaldosteronism/files/Investigating%20elevated%20potassium%20values..txt) Try to get this done about 4 hours after you have been out of bed.5. Send us the results with the normal values for your lab.6. If you ever have a salt (saline) infusion test for PA be certain to ask them to measure how much you pee during the 4 hours of the infusion. If it is 1-1.5 liter of urine it strongly suggests that you may have PA. If more tha 1.5 L you almost certainly have PA. I helped perfect this test and have probably done more saline infusions than anyone in the world. 8. Become a participant in our PA Registry and contribute to our large database on PA: If you have been Dxed with PA already and are on Rx or have had surgery please go to http://www.kwiksurveys.com/online-survey.php?surveyID=HIJIO_f2685379 and complete our survey with as much information as you know. If there is some information you don't know ask us and we will help. If you need to update this as you journey thru the diagnostic/treatment process you can add another entry but label it as Nameyymmdd. For example today 6/12/09 for me would be Grim090612. This ever increasing number will allow us and you to sort your multiple entries into a dated order. 9. Learn the language: If you are new to medical lingo then download the acroyms from http://health.groups.yahoo.com/group/bloodpressureline/message/2918610. Salt and high blood pressure: To learn the state of the science of salt and blood pressure please spend some time looking at http://www.worldactiononsalt.com/evidence/treatment_trials.htm11. Become a HBP expert consumer: Expect that it will take at least several weeks to get all this digested and to learn the new language of high blood pressure health care. As most doctors and nurses in practice have had very little training in high blood pressure you must become an expert yourself. For example most have never had anyone listen with them with a double stethoscope to verify that they can hear BP sounds. We cannot make you a doctor but we will make you a pretty good BP doctor. Read our consumer's guide to an accurate blood pressure.12. How High Blood Pressure should be managed: Go to nih.gov and download and read the Joint National Commission (JNC) Report 7 to get an overview on current guidelines. I ask all my secretaries to read this so they can communicate the importance of high blood pressure to my patients. JNC 8 will be out soon.Then: get (and study) the Hypertension Primer from americanheart.org 4th addition. I coauthored the chapter on BP measurement. You can also get this for about $6 from Amazon.com. This is the most up-to-date compendium of what is known about high blood pressure and what every Dr. should know when they graduate from Medical School. Every chapter is only 2-3 pages. Read one chapter every week-night and you will finish it in about a year. I am working on a reading guide for lay people for the Primer. Stay tuned. If you don't like it take it to your health care team so they will know what every medical student today should know.13. Ask us questions: Ask any questions about high blood pressure you want answered. That is what we are here for. We have had this site for 10 years and over 30,000 emails are searchable. This is the largest collection of communications about Conn's Syndrome in the World. 14. One-on-one Consulting: I can provide individual consulting if you do not want to go public. If you want individual one-on-one consulting for you and your Doctor contract me directly at lowerbp2@....15: Abbreviations of common use in aldo speak include: AME apparent mineralocorticoid excess AVS adrenal vein sampling BB beta blockers CCB calcium channel blockers Dx diagnosis FHx family history GRE glucocorticoid remedial aldosteronism LNaV8 low sodium V8 juice. MCB mineralocorticoid blocker also called AB aldosterone blocker. MHx medical history Rx treatment SHx social history UNaKCr urinary sodium, potassium, creatinine May your pressure be low!Clarence E. Grim BS, MS, MD, FACP, FACC, FAHA Council for High Blood Pressure Research. Board Certified in Internal Medicine, Geriatrics, and High Blood Pressure by the American Society of Hypertension. Retired Faculty/Professor of Medicine (U of MO, Indiana, UCLA/DREW, Medical College of Wisconsin in Nephrology, Endocrinology, Cardiology, and Epidemiology. Specializing in Primary Aldosteronism and Difficult to Control High Blood Pressure. One week after having my husband's HTN specialist increase his Inspra from 100mg each am to 150mg each am, I am happy to report his BP's have come down from the 150's/90's to 115-125/80-85. He was previously on spiro 100mg a day so I knew 100mg of Inspra wouldn't be enough but the specialist wanted to start low and work up.The correct dose of Inspra plus keeping his daily Na intake below 1500mg and K intake above 2000mg (one tall glass of low Na V8 is nearly one gram of K) has alleviated all of his PA symptoms. :)Hope everyone is doing well,Husband,43,finally diagnosed with PA (no renin, high ARR and aldosterone, very low K for years) after 5 years on 6 different BP meds in October 2010.)

[Guest guest]

I would hope that he is getting a lot more then 2000mg of K a day.

>

>

> One week after having my husband's HTN specialist increase his Inspra

> from 100mg each am to 150mg each am, I am happy to report his BP's have

> come down from the 150's/90's to 115-125/80-85. He was previously on

> spiro 100mg a day so I knew 100mg of Inspra wouldn't be enough but the

> specialist wanted to start low and work up.

>

> The correct dose of Inspra plus keeping his daily Na intake below 1500mg

> and K intake above 2000mg (one tall glass of low Na V8 is nearly one

> gram of K) has alleviated all of his PA symptoms.

>

> Hope everyone is doing well,

>

>

>

> Husband,43,finally diagnosed with PA (no renin, high ARR and

> aldosterone, very low K for years) after 5 years on 6 different BP meds

> in October 2010.)

>

[Guest guest]

He is getting more than 2000mg of K most days but probably not more than 3000mg

on any given day. The V8 is a rich source but we struggle with finding other

rich sources without eating potatoes every day. I guess two glasses of orange

juice added to his two glasses low Na V8 per day would get him closer, along

with Mrs. Dash on everything and a whole fresh tomato per day.

Any suggestions?

> >

> >

> > One week after having my husband's HTN specialist increase his Inspra

> > from 100mg each am to 150mg each am, I am happy to report his BP's have

> > come down from the 150's/90's to 115-125/80-85. He was previously on

> > spiro 100mg a day so I knew 100mg of Inspra wouldn't be enough but the

> > specialist wanted to start low and work up.

> >

> > The correct dose of Inspra plus keeping his daily Na intake below 1500mg

> > and K intake above 2000mg (one tall glass of low Na V8 is nearly one

> > gram of K) has alleviated all of his PA symptoms.

> >

> > Hope everyone is doing well,

> >

> >

> >

> > Husband,43,finally diagnosed with PA (no renin, high ARR and

> > aldosterone, very low K for years) after 5 years on 6 different BP meds

> > in October 2010.)

> >

>

[Guest guest]

From our links this chart gives MG of K per 100 grams. 100 grams = about 3.5 oz

Using the food charts

Important basics

Fat-soluble vitamins

Water-soluble vitamins

Elements

Others

- Elements -

26: POTASSIUM

Potassium, like sodium, is essential for normal body function. Potassium is necessary for muscle function, the transmission of nerve impulses and for carbohydrate and protein metabolism.

It is unlikely that we would have a dietary deficiency of potassium as it is present in a large number of foods. Deficiency can occur when there are large losses resulting from excessive urination or from prolonged vomiting and diarrhoea.

Although sodium is an important dietary factor in high blood pressure for some people, variations in the ratio of sodium and potassium will also affect blood pressure under certain circumstances. An increase in potassium intake appears to partly offset the adverse effect of sodium on blood pressure. If you are prone to high blood pressure it would be beneficial to decrease sodium intake and increase your dietary intake of potassium, by eating more foods that have low amounts of sodium and significant amounts of potassium, such as fruits and vegetables.

The use of potassium salts as substitutes for common salt (sodium chloride) is potentially dangerous, and overuse can be fatal. Excessive potassium intake can cause heart irregularities and can cause the heart to stop beating (cardiac arrest). Potassium supplements and bulk substitutes should not be used without medical advice. High potassium intake can be particularly dangerous for children.

POTASSIUM INTAKE

Recommended daily dietary intake of potassium (Australia):

Infants: Children:

Adults:

10-35 millimoles

25-140 millimoles

50-140 millimoles

0.4-1.4 grams

1.0-5.5 grams

2.0-5.5 grams

Elements

-

Sodium

Potassium

-

Calcium

-

Magnesium

-

Iron

-

Phosporus

-

Sulphur

-

Chlorine

-

Copper

-

Zinc

-

Iodine

-

Fluorine

-

Chromium

-

Manganese

-

Selenium

-

Cobalt

-

Molybdenum

-

Nickel

-

Tin

-

Silicon

-

Vanadium

-

Cadmium

Also on this page:- Potassium intake- Potassium RDI- Food charts

top

bottom

POTASSIUM Food Charts:

POTASSIUM:beverages

top

bottom

BEVERAGES

Potassium

milligrams per 100 grams

Food charts list:beveragescereals, biscuits,cakes,desertsegg and cheese dishesfats and oilsfish and seafoodsfruitmeat and meat productsmilk and milk productsnutssauces and condimentssoups (as served)sugars, jams and spreadssweetsvegetables

POTASSIUM:cereals/cakes

top

bottom

CEREALS, BISCUITS, CAKES, DESERTS

Potassium

milligrams per 100 grams

Food charts list:beveragescereals, biscuits,cakes,desertsegg and cheese dishesfats and oilsfish and seafoodsfruitmeat and meat productsmilk and milk productsnutssauces and condimentssoups (as served)sugars, jams and spreadssweetsvegetables

POTASSIUM:cereals/cakes

top

bottom

Food charts list:beveragescereals, biscuits,cakes,desertsegg and cheese dishesfats and oilsfish and seafoodsfruitmeat and meat productsmilk and milk productsnutssauces and condimentssoups (as served)sugars, jams and spreadssweetsvegetables

POTASSIUM:egg & cheesedishes

top

bottom

EGG AND CHEESE DISHES

Potassium

milligrams per 100 grams

POTASSIUM:fats/oils

top

bottom

FATS AND OILS

Potassium

milligrams per 100 grams

POTASSIUM:fish/seafood

top

bottom

FISH AND OTHER SEAFOODS

Potassium

milligrams per 100 grams

Food charts list:beveragescereals, biscuits,cakes,desertsegg and cheese dishesfats and oilsfish and seafoodsfruitmeat and meat productsmilk and milk productsnutssauces and condimentssoups (as served)sugars, jams and spreadssweetsvegetables

POTASSIUM:fruit

top

bottom

FRUIT

Potassium

milligrams per 100 grams

Food charts list:beveragescereals, biscuits,cakes,desertsegg and cheese dishesfats and oilsfish and seafoodsfruitmeat and meat productsmilk and milk productsnutssauces and condimentssoups (as served)sugars, jams and spreadssweetsvegetables

POTASSIUM:fruit

top

bottom

Food charts list:beveragescereals, biscuits,cakes,desertsegg and cheese dishesfats and oilsfish and seafoodsfruitmeat and meat productsmilk and milk productsnutssauces and condimentssoups (as served)sugars, jams and spreadssweetsvegetables

POTASSIUM:meats

top

bottom

MEAT AND MEAT PRODUCTS

Potassium

milligrams per 100 grams

Food charts list:beveragescereals, biscuits,cakes,desertsegg and cheese dishesfats and oilsfish and seafoodsfruitmeat and meat productsmilk and milk productsnutssauces and condimentssoups (as served)sugars, jams and spreadssweetsvegetables

POTASSIUM:meats

top

bottom

Food charts list:beveragescereals, biscuits,cakes,desertsegg and cheese dishesfats and oilsfish and seafoodsfruitmeat and meat productsmilk and milk productsnutssauces and condimentssoups (as served)sugars, jams and spreadssweetsvegetables

POTASSIUM:milk products

top

bottom

MILK AND MILK PRODUCTS

Potassium

milligrams per 100 grams

Food charts list:beveragescereals, biscuits,cakes,desertsegg and cheese dishesfats and oilsfish and seafoodsfruitmeat and meat productsmilk and milk productsnutssauces and condimentssoups (as served)sugars, jams and spreadssweetsvegetables

POTASSIUM:nuts

top

bottom

NUTS

Potassium

milligrams per 100 grams

POTASSIUM:sauces

top

bottom

SAUCES AND CONDIMENTS

Potassium

milligrams per 100 grams

Food charts list:beveragescereals, biscuits,cakes,desertsegg and cheese dishesfats and oilsfish and seafoodsfruitmeat and meat productsmilk and milk productsnutssauces and condimentssoups (as served)sugars, jams and spreadssweetsvegetables

POTASSIUM:soups

top

bottom

SOUPS (as served)

Potassium

milligrams per 100 grams

POTASSIUM:sugars

top

bottom

SUGARS, JAMS AND SPREADS

Potassium

milligrams per 100 grams

Food charts list:beveragescereals, biscuits,cakes,desertsegg and cheese dishesfats and oilsfish and seafoodsfruitmeat and meat productsmilk and milk productsnutssauces and condimentssoups (as served)sugars, jams and spreadssweetsvegetables

POTASSIUM:sweets

top

bottom

SWEETS

Potassium

milligrams per 100 grams

POTASSIUM:vegetables

top

bottom

VEGETABLES

Potassium

milligrams per 100 grams

Food charts list:beveragescereals, biscuits,cakes,desertsegg and cheese dishesfats and oilsfish and seafoodsfruitmeat and meat productsmilk and milk productsnutssauces and condimentssoups (as served)sugars, jams and spreadssweetsvegetables

POTASSIUM:vegetables

top

bottom

Food charts list:beveragescereals, biscuits,cakes,desertsegg and cheese dishesfats and oilsfish and seafoodsfruitmeat and meat productsmilk and milk productsnutssauces and condimentssoups (as served)sugars, jams and spreadssweetsvegetables

top

> > >> > > > > > One week after having my husband's HTN specialist increase his Inspra> > > from 100mg each am to 150mg each am, I am happy to report his BP's have> > > come down from the 150's/90's to 115-125/80-85. He was previously on> > > spiro 100mg a day so I knew 100mg of Inspra wouldn't be enough but the> > > specialist wanted to start low and work up.> > > > > > The correct dose of Inspra plus keeping his daily Na intake below 1500mg> > > and K intake above 2000mg (one tall glass of low Na V8 is nearly one> > > gram of K) has alleviated all of his PA symptoms. > > > > > > Hope everyone is doing well,> > > > > > > > > > > > Husband,43,finally diagnosed with PA (no renin, high ARR and> > > aldosterone, very low K for years) after 5 years on 6 different BP meds> > > in October 2010.)> > >> >>

[Guest guest]

Here's a pretty good list of foods high in potassium:

http://www.whfoods.com/genpage.php?tname=nutrient & dbid=90

For a less starchy/sugary option than potatoes or orange juice, you could add in

a salad made with spinach, mushrooms, bell pepper, avocado, etc.

> > >

> > >

> > > One week after having my husband's HTN specialist increase his Inspra

> > > from 100mg each am to 150mg each am, I am happy to report his BP's have

> > > come down from the 150's/90's to 115-125/80-85. He was previously on

> > > spiro 100mg a day so I knew 100mg of Inspra wouldn't be enough but the

> > > specialist wanted to start low and work up.

> > >

> > > The correct dose of Inspra plus keeping his daily Na intake below 1500mg

> > > and K intake above 2000mg (one tall glass of low Na V8 is nearly one

> > > gram of K) has alleviated all of his PA symptoms.

> > >

> > > Hope everyone is doing well,

> > >

> > >

> > >

> > > Husband,43,finally diagnosed with PA (no renin, high ARR and

> > > aldosterone, very low K for years) after 5 years on 6 different BP meds

> > > in October 2010.)

> > >

> >

>

[Guest guest]

Does he like whole fruits. We have a list of high K food in our files somewhere and you can google and find them.Potatoes are a good source of many things and relatively low calorie.Sweet potatoesBlack strap molasses is also good.Can he tolerate the taste of Co-salt or other K salt subs?CE Grim MD

[Guest guest]

This is better on per serving. Note beans etc. Note recomme ndation is 4700 mg which is the DASH recommendation.CE Grim MD Here's a pretty good list of foods high in potassium:http://www.whfoods.com/genpage.php?tname=nutrient & dbid=90For a less starchy/sugary option than potatoes or orange juice, you could add in a salad made with spinach, mushrooms, bell pepper, avocado, etc.> > >> > > > > > One week after having my husband's HTN specialist increase his Inspra> > > from 100mg each am to 150mg each am, I am happy to report his BP's have> > > come down from the 150's/90's to 115-125/80-85. He was previously on> > > spiro 100mg a day so I knew 100mg of Inspra wouldn't be enough but the> > > specialist wanted to start low and work up.> > > > > > The correct dose of Inspra plus keeping his daily Na intake below 1500mg> > > and K intake above 2000mg (one tall glass of low Na V8 is nearly one> > > gram of K) has alleviated all of his PA symptoms. > > > > > > Hope everyone is doing well,> > > > > > > > > > > > Husband,43,finally diagnosed with PA (no renin, high ARR and> > > aldosterone, very low K for years) after 5 years on 6 different BP meds> > > in October 2010.)> > >> >>

[Guest guest]

I use coconut water to get enough potassium. One can has ( 12 ounces has 685 mg potassium) plus it tastes great. 50 mg of Sodium. ( make sure you get the water not juice) From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Clarence GrimSent: Monday, April 04, 2011 11:11 AMTo: hyperaldosteronism Cc: Clarence GrimSubject: Re: Re: Update after increasing Inspra This is better on per serving. Note beans etc. Note recomme ndation is 4700 mg which is the DASH recommendation. CE Grim MD Here's a pretty good list of foods high in potassium:http://www.whfoods.com/genpage.php?tname=nutrient & dbid=90For a less starchy/sugary option than potatoes or orange juice, you could add in a salad made with spinach, mushrooms, bell pepper, avocado, etc.> > >> > > > > > One week after having my husband's HTN specialist increase his Inspra> > > from 100mg each am to 150mg each am, I am happy to report his BP's have> > > come down from the 150's/90's to 115-125/80-85. He was previously on> > > spiro 100mg a day so I knew 100mg of Inspra wouldn't be enough but the> > > specialist wanted to start low and work up.> > > > > > The correct dose of Inspra plus keeping his daily Na intake below 1500mg> > > and K intake above 2000mg (one tall glass of low Na V8 is nearly one> > > gram of K) has alleviated all of his PA symptoms. > > > > > > Hope everyone is doing well,> > > > > > > > > > > > Husband,43,finally diagnosed with PA (no renin, high ARR and> > > aldosterone, very low K for years) after 5 years on 6 different BP meds> > > in October 2010.)> > >> >>