Re: Question regarding Beta Blockers

[Guest guest]

BB are given if you have ever had an MI AND I DON'T recall that Hx. I use them in difficult HTN BUT because you have PA they would not be expected to have much of an effect. PA is not difficult to manage HTN. So it is reasonable to ask: can I step down my BB? Now that I am doing so well. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

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]

Nope, No MI that I am aware of! Maybe they considered I had difficult HTN when

they tried 7 different meds at the same time so they double-dosed me and it

still didn't work! And you mean I have to be diplomatic to boot!

- 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]

Nope, No MI that I am aware of! Maybe they considered I had difficult HTN when

they tried 7 different meds at the same time so they double-dosed me and it

still didn't work! And you mean I have to be diplomatic to boot!

- 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]

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.

> >

> >

>