Re: Re: Question regarding Beta Blockers

[Guest guest]

I try to avoid prescribing BB's at all costs. They have a place in some heart rate issues, and when there is an aortic aneurysm and it's crucial to decrease the force of contractions, and it instantly decreased half the symptoms when I had hyperthyroidism (like the heartbeat that felt like it was going to push right through my sternum! and the edginess)

But... I would often take the nursing home patients off of them and amazingly they had more energy, were more alert, and didn't feel like sleeping all day. they tried them on me in various forms over the years before PA was diagnosed and I could hardly take them as I had a natural slow heart rate and it made me sick. Only after the thyroid issue did they seem to help me a little.

My BB story,...when I went into the hospital last Sept for 5 days - before the PA was dx'd- i went in when my BP hit 180/140 . Went in feeling off, but not horrible. By day 2 I could not stop throwing up, had a headache beyond description and felt miserable. I was so sick and continously vomiting but they dc'd my IV to do a head CT and then the headache was gone. Get back to my room and the iv back in and headache back - bad. So I catch on and notice it was the KCl in my IV bag. I couldn;t see it well before and the patch on the bag wasn't yellow like the KCl often is. I had already told them the KCl gave me horrible horrible headaches (it's the chloride - I now know from asking Dr Grimm on this site) and then the nurse comes in with meds. I got suspicious and I asked her if she was giving me a BB. I was then on the tail end of the thyroid issus and took a BB at home but only 12.5 of metoprolol once a day.

Well I found out I had had, in 24 hours, 3 doses of metoprolol 100mg and she was in there to give me dose # 4. My heart rate was 46. I told the nurse I was not taking anymore that my heart rate was way too slow and then once I cleared my head I knew now why I came in feeling bad, but was now completely miserable.

But what did my notes say after that...I got my records.....it said I "refused to take the prescribed medication!" No.....actually, I refused to die is how I saw it.

Anyway, BB are often overlooked as a cause of a patients fatigue and weakness. Don't like them.

Good night.

Subject: Re: Question regarding Beta BlockersTo: hyperaldosteronism Date: Wednesday, August 24, 2011, 10:56 PM

Well, tried that and it didn't work! She said they treat me as if I had a MI when HTN is as advanced and long term as mine! (Guess I misunderstood Endrocolgist's instructions to stop all BP meds!) Well, that gave me a little research project for the afternoon!I can't decide whether to set up an appt for Jan. 2012 (after JNC-8 comes out) or spill the beans early! I found an article at:http://www.medscape.com/viewarticle/560968which sums up the current thinking very well and I appears to be the way JNC-8 is headed! It's long but very readable and interesting, especially if you are on a beta blocker! I can't resist posting one paragraph:Where Did We Go Wrong?Given this state-of-the-art paper, one may appropriately inquire about the evidence on which the seventh report of the Joint National Committee on prevention, detection,

evaluation, and treatment of high blood pressure (JNC 7) is based.[3] It appears that the guidelines were based mostly on trials like the STOP-2 (Swedish Trial in Old Patients with hypertension-2) trial,[19] the CONVINCE (Controlled ONset Verapamil INvestigation of Cardiovascular Endpoints) trial,[20] the NORDIL (Nordic Diltiazem) trial,[21] the CAPPP (Captopril Prevention Project) trial,[22] and most of all the meta-analysis by Psaty et al.[23] published in 1997. Although in some of these trials patients were started on a beta-blocker, more than two-thirds ended up on a combination of a beta-blocker with a diuretic, and no effort was made to separately analyze the morbidity and mortality effects of the beta-blocker, the diuretic, or the combination of the two. We[24] had earlier suggested that it would be erroneous to conclude from the results of these mixed trials that there was cardiovascular morbidity and mortality benefit of beta-blockers. To

illustrate the inappropriate use of including these studies as beta-blocker studies, we used an analogy model of the effects of gin and tonic on hepatic cirrhosis. One would hardly conclude that the tonic water caused cirrhosis based on a study in which two-thirds of patients were on gin and tonic and one-third on tonic water alone, and no attempt had been made to separately assess the effects.[24] My conclusion is that "you know who" was correct one more time when he said he only used bblockers for difficult to treat HTN (Maybe a little ahead of the times but then, maybe that is why he joined the elite FASH group!) - 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank & testicle pain. I have decided against an adrenalectomy at this time since Meds. are working so well. Current BP(last week ave): 123/69Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2. and PTSD.Meds: Duloxetine hcl 80 MG,

Mirtazapine 15 MG, Metoprolol Tartrate 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG. > >

> Can anyone (, Dr. G. or other RXing professionals) think of any reasion I should still be on Metoprolol Tartrate 100mg bid? Heart Rate ave. = 58.3 for last couple weeks. I found in answers.com that it appears to only do exactly what I don't need when administered unopposed and if I lived in Great Britain the guideline would be to "avoid diuretics and betablockers as first-line treatment for HTN due to the risk of diabetes".> > > > All I can find is reasons NOT to be administered alone: increases HTN, reduces coronary blood flow, LVF, And cardiac output and tissue perfusion by means of leaving the alpha adrenergic system simulation unopposed. Oh yea, also: causes constriction of air passages and should not be taken by people with obstructive airway disease (such as asthma, bronchitis, or emphysema. How do YOU spell COPD?> > > > I may have just answered my own question by looking in my HTN Primer and I

quote, "There is a weak positive relationship between PRA and BP response to b-blockade." (I think Dr. G. included them the last time he mentioned ACEI and ARBs.)> > > > I also notice, "Escalating doses of b-blockers and combined a-,b-blockers can induce salt and water retention..." (Let's see, recommended dose for Metropolol is 25-200 and I was on 200bid or 400/day - wonder why it took me 11 months to get my NA low enough for Spiro to work!!) Oh, I forgot I was on Furosmide once a day and as Dr. G. indicated due to short half life eliminating NA part of the day and storing it the rest! IT'S A WONDER THE ICE DIDN'T MELT UNDER MY FEET!> > > > Why didn't that darn Neprologist pay more attention to eliminating BP meds instead of spending 50 mins. trying to add them! Once (if/when) this is gone that will leave only an 81mg asprin for BP beside 50 mg of spiro. Maybe I need to self-medicate myself all the way!>

> > > (I thought about not posting this since I think I have it figured out well enough to discuss with my PCP tomorrow but decided to post in case it might help someone else or start a good discussion!)> > > > - 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank & testicle pain. I have decided against an adrenalectomy at this time since Meds. are working so well. Current BP(last week ave): 123/69> > Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2 and PTSD.> > Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG. > > > >>

[Guest guest]

But Htn is now not so advanced. Ask fir paper showing benefit OT doing this. Never heard of this approach but have only been doing this 45 years. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

Well, tried that and it didn't work! She said they treat me as if I had a MI when HTN is as advanced and long term as mine! (Guess I misunderstood Endrocolgist's instructions to stop all BP meds!) Well, that gave me a little research project for the afternoon!

I can't decide whether to set up an appt for Jan. 2012 (after JNC-8 comes out) or spill the beans early! I found an article at:

http://www.medscape.com/viewarticle/560968

which sums up the current thinking very well and I appears to be the way JNC-8 is headed! It's long but very readable and interesting, especially if you are on a beta blocker! I can't resist posting one paragraph:

Where Did We Go Wrong?

Given this state-of-the-art paper, one may appropriately inquire about the evidence on which the seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure (JNC 7) is based.[3] It appears that the guidelines were based mostly on trials like the STOP-2 (Swedish Trial in Old Patients with hypertension-2) trial,[19] the CONVINCE (Controlled ONset Verapamil INvestigation of Cardiovascular Endpoints) trial,[20] the NORDIL (Nordic Diltiazem) trial,[21] the CAPPP (Captopril Prevention Project) trial,[22] and most of all the meta-analysis by Psaty et al.[23] published in 1997. Although in some of these trials patients were started on a beta-blocker, more than two-thirds ended up on a combination of a beta-blocker with a diuretic, and no effort was made to separately analyze the morbidity and mortality effects of the beta-blocker, the diuretic, or the combination of the two. We[24] had earlier suggested that it would be erroneous

to conclude from the results of these mixed trials that there was cardiovascular morbidity and mortality benefit of beta-blockers. To illustrate the inappropriate use of including these studies as beta-blocker studies, we used an analogy model of the effects of gin and tonic on hepatic cirrhosis. One would hardly conclude that the tonic water caused cirrhosis based on a study in which two-thirds of patients were on gin and tonic and one-third on tonic water alone, and no attempt had been made to separately assess the effects.[24]

My conclusion is that "you know who" was correct one more time when he said he only used bblockers for difficult to treat HTN (Maybe a little ahead of the times but then, maybe that is why he joined the elite FASH group!)

- 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank & testicle pain. I have decided against an adrenalectomy at this time since Meds. are working so well. Current BP(last week ave): 123/69

Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2. and PTSD.

Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG.

>

> > Can anyone (, Dr. G. or other RXing professionals) think of any reasion I should still be on Metoprolol Tartrate 100mg bid? Heart Rate ave. = 58.3 for last couple weeks. I found in answers.com that it appears to only do exactly what I don't need when administered unopposed and if I lived in Great Britain the guideline would be to "avoid diuretics and betablockers as first-line treatment for HTN due to the risk of diabetes".

> >

> > All I can find is reasons NOT to be administered alone: increases HTN, reduces coronary blood flow, LVF, And cardiac output and tissue perfusion by means of leaving the alpha adrenergic system simulation unopposed. Oh yea, also: causes constriction of air passages and should not be taken by people with obstructive airway disease (such as asthma, bronchitis, or emphysema. How do YOU spell COPD?

> >

> > I may have just answered my own question by looking in my HTN Primer and I quote, "There is a weak positive relationship between PRA and BP response to b-blockade." (I think Dr. G. included them the last time he mentioned ACEI and ARBs.)

> >

> > I also notice, "Escalating doses of b-blockers and combined a-,b-blockers can induce salt and water retention..." (Let's see, recommended dose for Metropolol is 25-200 and I was on 200bid or 400/day - wonder why it took me 11 months to get my NA low enough for Spiro to work!!) Oh, I forgot I was on Furosmide once a day and as Dr. G. indicated due to short half life eliminating NA part of the day and storing it the rest! IT'S A WONDER THE ICE DIDN'T MELT UNDER MY FEET!

> >

> > Why didn't that darn Neprologist pay more attention to eliminating BP meds instead of spending 50 mins. trying to add them! Once (if/when) this is gone that will leave only an 81mg asprin for BP beside 50 mg of spiro. Maybe I need to self-medicate myself all the way!

> >

> > (I thought about not posting this since I think I have it figured out well enough to discuss with my PCP tomorrow but decided to post in case it might help someone else or start a good discussion!)

> >

> > - 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank & testicle pain. I have decided against an adrenalectomy at this time since Meds. are working so well. Current BP(last week ave): 123/69

> > Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2 and PTSD.

> > Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG.

> >

> >

>

[Guest guest]

My preference is bisoproprol BTW and they Are needed in difficult HTN AS part of the Combination of combinations I use. See my Difficult HTN handout in our files. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

I try to avoid prescribing BB's at all costs. They have a place in some heart rate issues, and when there is an aortic aneurysm and it's crucial to decrease the force of contractions, and it instantly decreased half the symptoms when I had hyperthyroidism (like the heartbeat that felt like it was going to push right through my sternum! and the edginess)

But... I would often take the nursing home patients off of them and amazingly they had more energy, were more alert, and didn't feel like sleeping all day. they tried them on me in various forms over the years before PA was diagnosed and I could hardly take them as I had a natural slow heart rate and it made me sick. Only after the thyroid issue did they seem to help me a little.

My BB story,...when I went into the hospital last Sept for 5 days - before the PA was dx'd- i went in when my BP hit 180/140 . Went in feeling off, but not horrible. By day 2 I could not stop throwing up, had a headache beyond description and felt miserable. I was so sick and continously vomiting but they dc'd my IV to do a head CT and then the headache was gone. Get back to my room and the iv back in and headache back - bad. So I catch on and notice it was the KCl in my IV bag. I couldn;t see it well before and the patch on the bag wasn't yellow like the KCl often is. I had already told them the KCl gave me horrible horrible headaches (it's the chloride - I now know from asking Dr Grimm on this site) and then the nurse comes in with meds. I got suspicious and I asked her if she was giving me a BB. I was then on the tail end of the thyroid issus and took a BB at home but only 12.5 of metoprolol once a day.

Well I found out I had had, in 24 hours, 3 doses of metoprolol 100mg and she was in there to give me dose # 4. My heart rate was 46. I told the nurse I was not taking anymore that my heart rate was way too slow and then once I cleared my head I knew now why I came in feeling bad, but was now completely miserable.

But what did my notes say after that...I got my records.....it said I "refused to take the prescribed medication!" No.....actually, I refused to die is how I saw it.

Anyway, BB are often overlooked as a cause of a patients fatigue and weakness. Don't like them.

Good night.

Subject: Re: Question regarding Beta BlockersTo: hyperaldosteronism Date: Wednesday, August 24, 2011, 10:56 PM

Well, tried that and it didn't work! She said they treat me as if I had a MI when HTN is as advanced and long term as mine! (Guess I misunderstood Endrocolgist's instructions to stop all BP meds!) Well, that gave me a little research project for the afternoon!I can't decide whether to set up an appt for Jan. 2012 (after JNC-8 comes out) or spill the beans early! I found an article at:http://www.medscape.com/viewarticle/560968which sums up the current thinking very well and I appears to be the way JNC-8 is headed! It's long but very readable and interesting, especially if you are on a beta blocker! I can't resist posting one paragraph:Where Did We Go Wrong?Given this state-of-the-art paper, one may appropriately inquire about the evidence on which the seventh report of the Joint National Committee on prevention, detection,

evaluation, and treatment of high blood pressure (JNC 7) is based.[3] It appears that the guidelines were based mostly on trials like the STOP-2 (Swedish Trial in Old Patients with hypertension-2) trial,[19] the CONVINCE (Controlled ONset Verapamil INvestigation of Cardiovascular Endpoints) trial,[20] the NORDIL (Nordic Diltiazem) trial,[21] the CAPPP (Captopril Prevention Project) trial,[22] and most of all the meta-analysis by Psaty et al.[23] published in 1997. Although in some of these trials patients were started on a beta-blocker, more than two-thirds ended up on a combination of a beta-blocker with a diuretic, and no effort was made to separately analyze the morbidity and mortality effects of the beta-blocker, the diuretic, or the combination of the two. We[24] had earlier suggested that it would be erroneous to conclude from the results of these mixed trials that there was cardiovascular morbidity and mortality benefit of beta-blockers. To

illustrate the inappropriate use of including these studies as beta-blocker studies, we used an analogy model of the effects of gin and tonic on hepatic cirrhosis. One would hardly conclude that the tonic water caused cirrhosis based on a study in which two-thirds of patients were on gin and tonic and one-third on tonic water alone, and no attempt had been made to separately assess the effects.[24] My conclusion is that "you know who" was correct one more time when he said he only used bblockers for difficult to treat HTN (Maybe a little ahead of the times but then, maybe that is why he joined the elite FASH group!) - 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank & testicle pain. I have decided against an adrenalectomy at this time since Meds. are working so well. Current BP(last week ave): 123/69Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2. and PTSD.Meds: Duloxetine hcl 80 MG,

Mirtazapine 15 MG, Metoprolol Tartrate 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG. > >

> Can anyone (, Dr. G. or other RXing professionals) think of any reasion I should still be on Metoprolol Tartrate 100mg bid? Heart Rate ave. = 58.3 for last couple weeks. I found in answers.com that it appears to only do exactly what I don't need when administered unopposed and if I lived in Great Britain the guideline would be to "avoid diuretics and betablockers as first-line treatment for HTN due to the risk of diabetes".> > > > All I can find is reasons NOT to be administered alone: increases HTN, reduces coronary blood flow, LVF, And cardiac output and tissue perfusion by means of leaving the alpha adrenergic system simulation unopposed. Oh yea, also: causes constriction of air passages and should not be taken by people with obstructive airway disease (such as asthma, bronchitis, or emphysema. How do YOU spell COPD?> > > > I may have just answered my own question by looking in my HTN Primer and I

quote, "There is a weak positive relationship between PRA and BP response to b-blockade." (I think Dr. G. included them the last time he mentioned ACEI and ARBs.)> > > > I also notice, "Escalating doses of b-blockers and combined a-,b-blockers can induce salt and water retention..." (Let's see, recommended dose for Metropolol is 25-200 and I was on 200bid or 400/day - wonder why it took me 11 months to get my NA low enough for Spiro to work!!) Oh, I forgot I was on Furosmide once a day and as Dr. G. indicated due to short half life eliminating NA part of the day and storing it the rest! IT'S A WONDER THE ICE DIDN'T MELT UNDER MY FEET!> > > > Why didn't that darn Neprologist pay more attention to eliminating BP meds instead of spending 50 mins. trying to add them! Once (if/when) this is gone that will leave only an 81mg asprin for BP beside 50 mg of spiro. Maybe I need to self-medicate myself all the way!>

> > > (I thought about not posting this since I think I have it figured out well enough to discuss with my PCP tomorrow but decided to post in case it might help someone else or start a good discussion!)> > > > - 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank & testicle pain. I have decided against an adrenalectomy at this time since Meds. are working so well. Current BP(last week ave): 123/69> > Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2 and PTSD.> > Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG. > > > >>

[Guest guest]

And I should have said I avoid it as a first line medicine. of all the BP meds the BB sure seem to alter the physical and alertness level and also many seem like they get depressed on them. Stop it, depression goes away. My wife was like that with labetolol - (took it in pregnancy only).

Subject: Re: Question regarding Beta BlockersTo: hyperaldosteronism Date: Wednesday, August 24, 2011, 10:56 PM

Well, tried that and it didn't work! She said they treat me as if I had a MI when HTN is as advanced and long term as mine! (Guess I misunderstood Endrocolgist's instructions to stop all BP meds!) Well, that gave me a little research project for the afternoon!I can't decide whether to set up an appt for Jan. 2012 (after JNC-8 comes out) or spill the beans early! I found an article at:http://www.medscape.com/viewarticle/560968which sums up the current thinking very well and I appears to be the way JNC-8 is headed! It's long but very readable and interesting, especially if you are on a beta blocker! I can't resist posting one paragraph:Where Did We Go Wrong?Given this state-of-the-art paper, one may appropriately inquire about the evidence on which the seventh report of the Joint National Committee on prevention, detection,

evaluation, and treatment of high blood pressure (JNC 7) is based.[3] It appears that the guidelines were based mostly on trials like the STOP-2 (Swedish Trial in Old Patients with hypertension-2) trial,[19] the CONVINCE (Controlled ONset Verapamil INvestigation of Cardiovascular Endpoints) trial,[20] the NORDIL (Nordic Diltiazem) trial,[21] the CAPPP (Captopril Prevention Project) trial,[22] and most of all the meta-analysis by Psaty et al.[23] published in 1997. Although in some of these trials patients were started on a beta-blocker, more than two-thirds ended up on a combination of a beta-blocker with a diuretic, and no effort was made to separately analyze the morbidity and mortality effects of the beta-blocker, the diuretic, or the combination of the two. We[24] had earlier suggested that it would be erroneous to conclude from the results of these mixed trials that there was cardiovascular morbidity and mortality benefit of beta-blockers. To

illustrate the inappropriate use of including these studies as beta-blocker studies, we used an analogy model of the effects of gin and tonic on hepatic cirrhosis. One would hardly conclude that the tonic water caused cirrhosis based on a study in which two-thirds of patients were on gin and tonic and one-third on tonic water alone, and no attempt had been made to separately assess the effects.[24] My conclusion is that "you know who" was correct one more time when he said he only used bblockers for difficult to treat HTN (Maybe a little ahead of the times but then, maybe that is why he joined the elite FASH group!) - 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank & testicle pain. I have decided against an adrenalectomy at this time since Meds. are working so well. Current BP(last week ave): 123/69Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2. and PTSD.Meds: Duloxetine hcl 80 MG,

Mirtazapine 15 MG, Metoprolol Tartrate 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG. > > > Can anyone (, Dr. G. or other RXing

professionals) think of any reasion I should still be on Metoprolol Tartrate 100mg bid? Heart Rate ave. = 58.3 for last couple weeks. I found in answers.com that it appears to only do exactly what I don't need when administered unopposed and if I lived in Great Britain the guideline would be to "avoid diuretics and betablockers as first-line treatment for HTN due to the risk of diabetes".> > > > All I can find is reasons NOT to be administered alone: increases HTN, reduces coronary blood flow, LVF, And cardiac output and tissue perfusion by means of leaving the alpha adrenergic system simulation unopposed. Oh yea, also: causes constriction of air passages and should not be taken by people with obstructive airway disease (such as asthma, bronchitis, or emphysema. How do YOU spell COPD?> > > > I may have just answered my own question by looking in my HTN Primer and I quote, "There is a weak positive relationship

between PRA and BP response to b-blockade." (I think Dr. G. included them the last time he mentioned ACEI and ARBs.)> > > > I also notice, "Escalating doses of b-blockers and combined a-,b-blockers can induce salt and water retention..." (Let's see, recommended dose for Metropolol is 25-200 and I was on 200bid or 400/day - wonder why it took me 11 months to get my NA low enough for Spiro to work!!) Oh, I forgot I was on Furosmide once a day and as Dr. G. indicated due to short half life eliminating NA part of the day and storing it the rest! IT'S A WONDER THE ICE DIDN'T MELT UNDER MY FEET!> > > > Why didn't that darn Neprologist pay more attention to eliminating BP meds instead of spending 50 mins. trying to add them! Once (if/when) this is gone that will leave only an 81mg asprin for BP beside 50 mg of spiro. Maybe I need to self-medicate myself all the way!> > > > (I thought about not posting

this since I think I have it figured out well enough to discuss with my PCP tomorrow but decided to post in case it might help someone else or start a good discussion!)> > > > - 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank & testicle pain. I have decided against an adrenalectomy at this time since Meds. are working so well. Current BP(last week ave): 123/69> > Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2 and PTSD.> > Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG. > > > >>

[Guest guest]

May want to try bisoprolol in some folks. See my cocktail in the Evolution article and my difficult HTN handout in our files.CE Grim MD And I should have said I avoid it as a first line medicine. of all the BP meds the BB sure seem to alter the physical and alertness level and also many seem like they get depressed on them. Stop it, depression goes away. My wife was like that with labetolol - (took it in pregnancy only). Subject: Re: Question regarding Beta BlockersTo: hyperaldosteronism Date: Wednesday, August 24, 2011, 10:56 PM Well, tried that and it didn't work! She said they treat me as if I had a MI when HTN is as advanced and long term as mine! (Guess I misunderstood Endrocolgist's instructions to stop all BP meds!) Well, that gave me a little research project for the afternoon!I can't decide whether to set up an appt for Jan. 2012 (after JNC-8 comes out) or spill the beans early! I found an article at:http://www.medscape.com/viewarticle/560968which sums up the current thinking very well and I appears to be the way JNC-8 is headed! It's long but very readable and interesting, especially if you are on a beta blocker! I can't resist posting one paragraph:Where Did We Go Wrong?Given this state-of-the-art paper, one may appropriately inquire about the evidence on which the seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure (JNC 7) is based.[3] It appears that the guidelines were based mostly on trials like the STOP-2 (Swedish Trial in Old Patients with hypertension-2) trial,[19] the CONVINCE (Controlled ONset Verapamil INvestigation of Cardiovascular Endpoints) trial,[20] the NORDIL (Nordic Diltiazem) trial,[21] the CAPPP (Captopril Prevention Project) trial,[22] and most of all the meta-analysis by Psaty et al.[23] published in 1997. Although in some of these trials patients were started on a beta-blocker, more than two-thirds ended up on a combination of a beta-blocker with a diuretic, and no effort was made to separately analyze the morbidity and mortality effects of the beta-blocker, the diuretic, or the combination of the two. We[24] had earlier suggested that it would be erroneous to conclude from the results of these mixed trials that there was cardiovascular morbidity and mortality benefit of beta-blockers. To illustrate the inappropriate use of including these studies as beta-blocker studies, we used an analogy model of the effects of gin and tonic on hepatic cirrhosis. One would hardly conclude that the tonic water caused cirrhosis based on a study in which two-thirds of patients were on gin and tonic and one-third on tonic water alone, and no attempt had been made to separately assess the effects.[24] My conclusion is that "you know who" was correct one more time when he said he only used bblockers for difficult to treat HTN (Maybe a little ahead of the times but then, maybe that is why he joined the elite FASH group!) - 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank & testicle pain. I have decided against an adrenalectomy at this time since Meds. are working so well. Current BP(last week ave): 123/69Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2. and PTSD.Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG. > > > Can anyone (, Dr. G. or other RXing professionals) think of any reasion I should still be on Metoprolol Tartrate 100mg bid? Heart Rate ave. = 58.3 for last couple weeks. I found in answers.com that it appears to only do exactly what I don't need when administered unopposed and if I lived in Great Britain the guideline would be to "avoid diuretics and betablockers as first-line treatment for HTN due to the risk of diabetes".> > > > All I can find is reasons NOT to be administered alone: increases HTN, reduces coronary blood flow, LVF, And cardiac output and tissue perfusion by means of leaving the alpha adrenergic system simulation unopposed. Oh yea, also: causes constriction of air passages and should not be taken by people with obstructive airway disease (such as asthma, bronchitis, or emphysema. How do YOU spell COPD?> > > > I may have just answered my own question by looking in my HTN Primer and I quote, "There is a weak positive relationship between PRA and BP response to b-blockade." (I think Dr. G. included them the last time he mentioned ACEI and ARBs.)> > > > I also notice, "Escalating doses of b-blockers and combined a-,b-blockers can induce salt and water retention..." (Let's see, recommended dose for Metropolol is 25-200 and I was on 200bid or 400/day - wonder why it took me 11 months to get my NA low enough for Spiro to work!!) Oh, I forgot I was on Furosmide once a day and as Dr. G. indicated due to short half life eliminating NA part of the day and storing it the rest! IT'S A WONDER THE ICE DIDN'T MELT UNDER MY FEET!> > > > Why didn't that darn Neprologist pay more attention to eliminating BP meds instead of spending 50 mins. trying to add them! Once (if/when) this is gone that will leave only an 81mg asprin for BP beside 50 mg of spiro. Maybe I need to self-medicate myself all the way!> > > > (I thought about not posting this since I think I have it figured out well enough to discuss with my PCP tomorrow but decided to post in case it might help someone else or start a good discussion!)> > > > - 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank & testicle pain. I have decided against an adrenalectomy at this time since Meds. are working so well. Current BP(last week ave): 123/69> > Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2 and PTSD.> > Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG. > > > >>

[Guest guest]

will do

>May want to try bisoprolol in some folks. See my cocktail in the Evolution

article and my difficult HTN handout in our files.

>

>CE Grim MD

>

>

>> And I should have said I avoid it as a first line medicine. of all the BP

meds the BB sure seem to alter the physical and alertness level and also many

seem like they get depressed on them. Stop it, depression goes away. My wife was

like that with labetolol - (took it in pregnancy only).

>>

>>

>>

>>

>> Subject: Re: Question regarding Beta Blockers

>> To: hyperaldosteronism

>> Date: Wednesday, August 24, 2011, 10:56 PM

>>

>>

>> Well, tried that and it didn't work! She said they treat me as if I had a MI

when HTN is as advanced and long term as mine! (Guess I misunderstood

Endrocolgist's instructions to stop all BP meds!) Well, that gave me a little

research project for the afternoon!

>>

>> I can't decide whether to set up an appt for Jan. 2012 (after JNC-8 comes

out) or spill the beans early! I found an article at:

>>

>> http://www.medscape.com/viewarticle/560968

>>

>> which sums up the current thinking very well and I appears to be the way

JNC-8 is headed! It's long but very readable and interesting, especially if you

are on a beta blocker! I can't resist posting one paragraph:

>>

>> Where Did We Go Wrong?

>> Given this state-of-the-art paper, one may appropriately inquire about the

evidence on which the seventh report of the Joint National Committee on

prevention, detection, evaluation, and treatment of high blood pressure (JNC 7)

is based.[3] It appears that the guidelines were based mostly on trials like the

STOP-2 (Swedish Trial in Old Patients with hypertension-2) trial,[19] the

CONVINCE (Controlled ONset Verapamil INvestigation of Cardiovascular Endpoints)

trial,[20] the NORDIL (Nordic Diltiazem) trial,[21] the CAPPP (Captopril

Prevention Project) trial,[22] and most of all the meta-analysis by Psaty et

al.[23] published in 1997. Although in some of these trials patients were

started on a beta-blocker, more than two-thirds ended up on a combination of a

beta-blocker with a diuretic, and no effort was made to separately analyze the

morbidity and mortality effects of the beta-blocker, the diuretic, or the

combination of the two. We[24] had earlier

suggested that it would be erroneous to conclude from the results of these

mixed trials that there was cardiovascular morbidity and mortality benefit of

beta-blockers. To illustrate the inappropriate use of including these studies as

beta-blocker studies, we used an analogy model of the effects of gin and tonic

on hepatic cirrhosis. One would hardly conclude that the tonic water caused

cirrhosis based on a study in which two-thirds of patients were on gin and tonic

and one-third on tonic water alone, and no attempt had been made to separately

assess the effects.[24]

>>

>> My conclusion is that " you know who " was correct one more time when he said

he only used bblockers for difficult to treat HTN (Maybe a little ahead of the

times but then, maybe that is why he joined the elite FASH group!)

>>

>> - 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma with previous rt.

flank & testicle pain. I have decided against an adrenalectomy at this time

since Meds. are working so well. Current BP(last week ave): 123/69

>> Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2. and PTSD.

>> Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate 200 MG,

81mg asprin, Metformin 2000MG and Spironolactone 50 MG.

>>

>>

>> >

>> > > Can anyone (, Dr. G. or other RXing professionals) think of any

reasion I should still be on Metoprolol Tartrate 100mg bid? Heart Rate ave. =

58.3 for last couple weeks. I found in answers.com that it appears to only do

exactly what I don't need when administered unopposed and if I lived in Great

Britain the guideline would be to " avoid diuretics and betablockers as

first-line treatment for HTN due to the risk of diabetes " .

>> > >

>> > > All I can find is reasons NOT to be administered alone: increases HTN,

reduces coronary blood flow, LVF, And cardiac output and tissue perfusion by

means of leaving the alpha adrenergic system simulation unopposed. Oh yea, also:

causes constriction of air passages and should not be taken by people with

obstructive airway disease (such as asthma, bronchitis, or emphysema. How do YOU

spell COPD?

>> > >

>> > > I may have just answered my own question by looking in my HTN Primer and

I quote, " There is a weak positive relationship between PRA and BP response to

b-blockade. " (I think Dr. G. included them the last time he mentioned ACEI and

ARBs.)

>> > >

>> > > I also notice, " Escalating doses of b-blockers and combined a-,b-blockers

can induce salt and water retention... " (Let's see, recommended dose for

Metropolol is 25-200 and I was on 200bid or 400/day - wonder why it took me 11

months to get my NA low enough for Spiro to work!!) Oh, I forgot I was on

Furosmide once a day and as Dr. G. indicated due to short half life eliminating

NA part of the day and storing it the rest! IT'S A WONDER THE ICE DIDN'T MELT

UNDER MY FEET!

>> > >

>> > > Why didn't that darn Neprologist pay more attention to eliminating BP

meds instead of spending 50 mins. trying to add them! Once (if/when) this is

gone that will leave only an 81mg asprin for BP beside 50 mg of spiro. Maybe I

need to self-medicate myself all the way!

>> > >

>> > > (I thought about not posting this since I think I have it figured out

well enough to discuss with my PCP tomorrow but decided to post in case it might

help someone else or start a good discussion!)

>> > >

>> > > - 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma with previous rt.

flank & testicle pain. I have decided against an adrenalectomy at this time

since Meds. are working so well. Current BP(last week ave): 123/69

>> > > Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2 and PTSD.

>> > > Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate 200

MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG.

>> > >

>> > >

>> >

>>

>>

>>

>