Re: Hypertension Primer and DASH Bible are Here

[Guest guest]

Good reading. Did u do the chap by the Grim's on BP MEASUREMENT? We thought it should be the first chapter. But could not convince them that all of the rest of the Primer depends on an accurate BP. With out this the rest of the Primer is a house built on sand. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

Talk about going from rags to riches, I feel like the cat with two litterboxes - don't know which one to use first!

Finally gave DASH to the meal planner, shopper and cook and dove into the HTN Primer. Paid for itself in less than half an hour!

Judging from their (Nepherologist) drug mix and conversation they are using the wrong chapter! They appear to be using C131 - ALDOSTERONE BLOCKERS AND POTASSIUM-SPARING DIURETICS (for regular HTN) and should be using C167 - MANAGEMENT OF HYPERALDOSTERONISM AND HYPERCORTISOLISM!

Under Other Drugs it specifically says, "ACE inhibitors and ARBs are generally ineffective because angiotensin II is supressed in PA. Addition of other diuretics can be tried but tend to lower serum K+.

The risk of hyperkalemia is increased in patients with CKD, including the elderly and patients with diabetes, where serum K+ level should be monitored more closely."

Now, don't I remember some doctor on this site telling me to ask them how the ACEI will work without any angiotensin to work on! Go figure!

Actually it says treat with Spiro. "and other drugs needed to control BP". Let see, at 123/71 do you think I need 3 or 4 more meds? ;>)

- 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): 123/71

Other Issues/Opportunities: COPD w/ft Oxygen, 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 75 MG.

[Guest guest]

That is such a great point because we in medicine get so fixated on "levels" or numbers and keep being taught to be "aggressive" without any critical thinking anymore, like adding more and more meds instead of one med and REALLY encouraging diet and exercise. Seems more or less that damn cookbook method and it drives me crazy. A good history, listening to the patient, and making an informed decision is almost forgotten - some patients say if their BP hits 120 (even 130) they get real dizzy so I will change our goal til we figure out why, or the blood sugar for example is a big one - they scare the living doo doo out of the "borderline diabetic" and fixate them on 120 and when they go have a nice healthy meal and suddenly jump to 140 - which is fine after a meal, they then have the patient on the phone panicking or showing up at

the ER scared that their medicine is not working or their dying of a diabetic coma (even as they're talking to you)..

Then again maybe I am just crazy and no one really needs to drive me there........

Talk about going from rags to riches, I feel like the cat with two litterboxes - don't know which one to use first!Finally gave DASH to the meal planner, shopper and cook and dove into the HTN Primer. Paid for itself in less than half an hour!Judging from their (Nepherologist) drug mix and conversation they are using the wrong chapter! They appear to be using C131 - ALDOSTERONE BLOCKERS AND POTASSIUM-SPARING DIURETICS (for regular HTN) and should be using C167 - MANAGEMENT OF HYPERALDOSTERONISM AND HYPERCORTISOLISM!Under Other Drugs it specifically says, "ACE inhibitors and ARBs are generally ineffective because angiotensin II is supressed in PA. Addition of other diuretics can be tried but tend to lower serum K+. The risk of hyperkalemia is increased in patients with CKD, including the elderly and patients with diabetes, where serum K+ level should be monitored more closely."Now, don't I remember some doctor on

this site telling me to ask them how the ACEI will work without any angiotensin to work on! Go figure!Actually it says treat with Spiro. "and other drugs needed to control BP". Let see, at 123/71 do you think I need 3 or 4 more meds? ;>) - 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): 123/71Other Issues/Opportunities: COPD w/ft Oxygen, OSA w Bi-Pap settings 13/19, DM2. and PTSDMeds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 75 MG.

[Guest guest]

Honest to God, that is the very first chapter (C103) that I looked at, I just

didn't notice the authors! (That was my test to know they knew what they were

talking about! Good thing it passed the test!) At least they were smart enough

to put it first in the Clinial Mgmt. Section!

I don't think I ever told you but I was talking with my Neice about PA (she is a

RN in her mid 40s). As I was explaining she stopped me and said, " Uncle , I

know what PA is. The first body I ever saw as a student nurse was an auto

accident and he had a med. emergency and didn't survive. We found a tumor in an

adrenal during the autopsy and I have NEVER forgotten! " (Too bad she is now an

Elementary Schoo Nurse!)

Hasn't medicine come a long way!

- 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): 123/71

Other Issues/Opportunities: COPD w/ft Oxygen, 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 75 MG.

>

> > Talk about going from rags to riches, I feel like the cat with two

litterboxes - don't know which one to use first!

> >

> > Finally gave DASH to the meal planner, shopper and cook and dove into the

HTN Primer. Paid for itself in less than half an hour!

> >

> > Judging from their (Nepherologist) drug mix and conversation they are using

the wrong chapter! They appear to be using C131 - ALDOSTERONE BLOCKERS AND

POTASSIUM-SPARING DIURETICS (for regular HTN) and should be using C167 -

MANAGEMENT OF HYPERALDOSTERONISM AND HYPERCORTISOLISM!

> >

> > Under Other Drugs it specifically says, " ACE inhibitors and ARBs are

generally ineffective because angiotensin II is supressed in PA. Addition of

other diuretics can be tried but tend to lower serum K+.

> > The risk of hyperkalemia is increased in patients with CKD, including the

elderly and patients with diabetes, where serum K+ level should be monitored

more closely. "

> >

> > Now, don't I remember some doctor on this site telling me to ask them how

the ACEI will work without any angiotensin to work on! Go figure!

> >

> > Actually it says treat with Spiro. " and other drugs needed to control BP " .

Let see, at 123/71 do you think I need 3 or 4 more meds? ;>)

> >

> > - 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): 123/71

> > Other Issues/Opportunities: COPD w/ft Oxygen, 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 75 MG.

> >

> >

>

[Guest guest]

and you should have consulted her earlier.CE Grim MD Honest to God, that is the very first chapter (C103) that I looked at, I just didn't notice the authors! (That was my test to know they knew what they were talking about! Good thing it passed the test!) At least they were smart enough to put it first in the Clinial Mgmt. Section! I don't think I ever told you but I was talking with my Neice about PA (she is a RN in her mid 40s). As I was explaining she stopped me and said, "Uncle , I know what PA is. The first body I ever saw as a student nurse was an auto accident and he had a med. emergency and didn't survive. We found a tumor in an adrenal during the autopsy and I have NEVER forgotten!" (Too bad she is now an Elementary Schoo Nurse!) Hasn't medicine come a long way! - 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): 123/71 Other Issues/Opportunities: COPD w/ft Oxygen, 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 75 MG. > > > Talk about going from rags to riches, I feel like the cat with two litterboxes - don't know which one to use first! > > > > Finally gave DASH to the meal planner, shopper and cook and dove into the HTN Primer. Paid for itself in less than half an hour! > > > > Judging from their (Nepherologist) drug mix and conversation they are using the wrong chapter! They appear to be using C131 - ALDOSTERONE BLOCKERS AND POTASSIUM-SPARING DIURETICS (for regular HTN) and should be using C167 - MANAGEMENT OF HYPERALDOSTERONISM AND HYPERCORTISOLISM! > > > > Under Other Drugs it specifically says, "ACE inhibitors and ARBs are generally ineffective because angiotensin II is supressed in PA. Addition of other diuretics can be tried but tend to lower serum K+. > > The risk of hyperkalemia is increased in patients with CKD, including the elderly and patients with diabetes, where serum K+ level should be monitored more closely." > > > > Now, don't I remember some doctor on this site telling me to ask them how the ACEI will work without any angiotensin to work on! Go figure! > > > > Actually it says treat with Spiro. "and other drugs needed to control BP". Let see, at 123/71 do you think I need 3 or 4 more meds? ;>) > > > > - 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): 123/71 > > Other Issues/Opportunities: COPD w/ft Oxygen, 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 75 MG. > > > > >