RE: Spiro Dosage - upper limit of 50mg?

[Guest guest]

Hi Carol,

Dr. Grim can give you a definite answer but I

personally take 100 mg of spiro twice per day. The MD

who diagnosed me at the University of Michigan told me

that PA's can go as high as 400 mg per day. Maybe

it's a cardiology thing because mine flips out about

my dosage, too. But that's the amount necessary to

keep my BP under control. I also DASH and usually get

between 1400-1800 mg NA per day. How's your BP?

a

--- Carol Christie <carolch@...> wrote:

> Since I was diagnosed with PA in 2004, I was

> prescribed initially 12.5

> mg per day of spiro and from 2006, 25mg per day. I

> have recently got

> agreement from the cardiologist to increase to 50mg

> - he is very

> reluctant about it, citing side effects.

> For the past couple of weeks, I have felt so much

> better - no episodes

> of brain fog leading to extreme exhaustion. I almost

> feel normal!!!

> I can't help but wonder why I have suffered

> debilitating symptoms for

> the last 4 years, if so simple a solution was

> possible. I have not been

> able to work, and my quality of life has been poor.

> I was told not to increase from 50mg per day as that

> is the maximum dose

> necessary to blockade all aldosterone receptors in

> the body.

> Would really appreciate your comments, Dr Grim and

> others.

> Carol (in Australia)

>

[Guest guest]

So sad, Carol, that your doctors don't understand spiro. What you were told

about 50 mg being the max dose is simply not true. I'm sure Dr. Grim will

chime in.

Val

From: hyperaldosteronism

[mailto:hyperaldosteronism ] On Behalf Of Carol Christie

Since I was diagnosed with PA in 2004, I was prescribed initially 12.5

mg per day of spiro and from 2006, 25mg per day. I have recently got

agreement from the cardiologist to increase to 50mg - he is very

reluctant about it, citing side effects.

For the past couple of weeks, I have felt so much better - no episodes

of brain fog leading to extreme exhaustion. I almost feel normal!!!

I can't help but wonder why I have suffered debilitating symptoms for

the last 4 years, if so simple a solution was possible. I have not been

able to work, and my quality of life has been poor.

I was told not to increase from 50mg per day as that is the maximum dose

necessary to blockade all aldosterone receptors in the body.

Would really appreciate your comments, Dr Grim and others.

Carol (in Australia)

[Guest guest]

Hi a

My BP is averaging 140/75 - the systolic varies from 120 to 160, while

the diastolic doesn't seem to vary very much, whatever that means...

Have you had any problems with spiro?

I am also taking 240 mg verapamil, 150mg irbesartan and 150mg

efexor(depression/anxiety). I asked the cardio about reducing the

verapamil, but he said not to. I would like to come off any unnecessary

medications. Indeed if spiro continues to work, I really want to get off

the antidepressant. I feel sure the PA is instrumental in the

depression/anxiety symptoms.

Carol

a Hall wrote:

>

> Hi Carol,

> Dr. Grim can give you a definite answer but I

> personally take 100 mg of spiro twice per day. The MD

> who diagnosed me at the University of Michigan told me

> that PA's can go as high as 400 mg per day. Maybe

> it's a cardiology thing because mine flips out about

> my dosage, too. But that's the amount necessary to

> keep my BP under control. I also DASH and usually get

> between 1400-1800 mg NA per day. How's your BP?

>

> a

>

> --- Carol Christie <carolch@... <mailto:carolch%40gil.com.au>>

> wrote:

>

> > Since I was diagnosed with PA in 2004, I was

> > prescribed initially 12.5

> > mg per day of spiro and from 2006, 25mg per day. I

> > have recently got

> > agreement from the cardiologist to increase to 50mg

> > - he is very

> > reluctant about it, citing side effects.

> > For the past couple of weeks, I have felt so much

> > better - no episodes

> > of brain fog leading to extreme exhaustion. I almost

> > feel normal!!!

> > I can't help but wonder why I have suffered

> > debilitating symptoms for

> > the last 4 years, if so simple a solution was

> > possible. I have not been

> > able to work, and my quality of life has been poor.

> > I was told not to increase from 50mg per day as that

> > is the maximum dose

> > necessary to blockade all aldosterone receptors in

> > the body.

> > Would really appreciate your comments, Dr Grim and

> > others.

> > Carol (in Australia)

> >

>

>

> ------------------------------------------------------------------------

>

> No virus found in this incoming message.

> Checked by AVG.

> Version: 7.5.524 / Virus Database: 269.24.1/1466 - Release Date: 25/05/2008

6:49 PM

>

[Guest guest]

Hello Val

Thanks for your comment - hearing each other's stories helps confirm the

validity of our own experience. Thanks for all your posts, and I trust

you get some answers soon. One of the hardest things for me has been

loss of skills related to organising, planning etc. The effect on my

brain I find so frustrating. Almost like it's an acquired brain injury.

Carol

Valarie wrote:

>

> So sad, Carol, that your doctors don't understand spiro. What you were

> told

> about 50 mg being the max dose is simply not true. I'm sure Dr. Grim will

> chime in.

>

> Val

>

> From: hyperaldosteronism

> <mailto:hyperaldosteronism%40>

> [mailto:hyperaldosteronism

> <mailto:hyperaldosteronism%40>] On Behalf Of Carol Christie

>

> Since I was diagnosed with PA in 2004, I was prescribed initially 12.5

> mg per day of spiro and from 2006, 25mg per day. I have recently got

> agreement from the cardiologist to increase to 50mg - he is very

> reluctant about it, citing side effects.

> For the past couple of weeks, I have felt so much better - no episodes

> of brain fog leading to extreme exhaustion. I almost feel normal!!!

> I can't help but wonder why I have suffered debilitating symptoms for

> the last 4 years, if so simple a solution was possible. I have not been

> able to work, and my quality of life has been poor.

> I was told not to increase from 50mg per day as that is the maximum dose

> necessary to blockade all aldosterone receptors in the body.

> Would really appreciate your comments, Dr Grim and others.

> Carol (in Australia)

>

>

[Guest guest]

Carol, do you feel the Effexor is working well for your anxiety and

depression?

Val

From: hyperaldosteronism

[mailto:hyperaldosteronism ] On Behalf Of Carol Christie

Hi a

My BP is averaging 140/75 - the systolic varies from 120 to 160, while

the diastolic doesn't seem to vary very much, whatever that means...

Have you had any problems with spiro?

I am also taking 240 mg verapamil, 150mg irbesartan and 150mg

efexor(depression/anxiety). I asked the cardio about reducing the

verapamil, but he said not to. I would like to come off any unnecessary

medications. Indeed if spiro continues to work, I really want to get off

the antidepressant. I feel sure the PA is instrumental in the

depression/anxiety symptoms.

Carol

[Guest guest]

Oh, Carol, I understand. I can't concentrate worth a damn now. In 2001 -

02, I was the president of my women's political group. I organized all

sorts of stuff - teach-ins, speakers, scholarships, etc. I was also the

vice chair of my political party. Doing all that organizing for caucuses,

assemblies, conventions, etc., is a lot of work. I just gave up my delegate

position to the state convention because my nerves cannot tolerate the

noise, commotion, and crowded conditions. Yeah, I kind of feel a bit brain

damaged.

I'm on 150 mg of spiro and have gone back estradiol. I'm worried if the

progesterone is going to work when I have to use it. I've read that spiro

blocks the effects of progesterone.

Val

From: hyperaldosteronism

[mailto:hyperaldosteronism ] On Behalf Of Carol Christie

Hello Val

Thanks for your comment - hearing each other's stories helps confirm the

validity of our own experience. Thanks for all your posts, and I trust

you get some answers soon. One of the hardest things for me has been

loss of skills related to organising, planning etc. The effect on my

brain I find so frustrating. Almost like it's an acquired brain injury.

Carol

[Guest guest]

I cannot imagine a Dr with experience in treating PA being reluctant

to use more than 50 mg of spiro.

We go up to 400 per day.

I did send a query to Dr. Stowasser in Brisbane about your Drs

concern and he was trying to track him down to bring him up to date.

If you can give me his name that will help.

Unless you are a different Aussie with PA.

On May 25, 2008, at 7:38 PM, Carol Christie wrote:

> Since I was diagnosed with PA in 2004, I was prescribed initially 12.5

> mg per day of spiro and from 2006, 25mg per day. I have recently got

> agreement from the cardiologist to increase to 50mg - he is very

> reluctant about it, citing side effects.

> For the past couple of weeks, I have felt so much better - no episodes

> of brain fog leading to extreme exhaustion. I almost feel normal!!!

> I can't help but wonder why I have suffered debilitating symptoms for

> the last 4 years, if so simple a solution was possible. I have not

> been

> able to work, and my quality of life has been poor.

> I was told not to increase from 50mg per day as that is the maximum

> dose

> necessary to blockade all aldosterone receptors in the body.

> Would really appreciate your comments, Dr Grim and others.

> Carol (in Australia)

[Guest guest]

Take your Cards person my article in our files.

Keep DASHing as well.

Yes you have likely been suffering from under treatment of PA.

On May 25, 2008, at 8:37 PM, Valarie wrote:

> So sad, Carol, that your doctors don't understand spiro. What you

> were told

> about 50 mg being the max dose is simply not true. I'm sure Dr.

> Grim will

> chime in.

>

> Val

>

> From: hyperaldosteronism

> [mailto:hyperaldosteronism ] On Behalf Of Carol

> Christie

>

> Since I was diagnosed with PA in 2004, I was prescribed initially 12.5

> mg per day of spiro and from 2006, 25mg per day. I have recently got

> agreement from the cardiologist to increase to 50mg - he is very

> reluctant about it, citing side effects.

> For the past couple of weeks, I have felt so much better - no episodes

> of brain fog leading to extreme exhaustion. I almost feel normal!!!

> I can't help but wonder why I have suffered debilitating symptoms for

> the last 4 years, if so simple a solution was possible. I have not

> been

> able to work, and my quality of life has been poor.

> I was told not to increase from 50mg per day as that is the maximum

> dose

> necessary to blockade all aldosterone receptors in the body.

> Would really appreciate your comments, Dr Grim and others.

> Carol (in Australia)

>

>

[Guest guest]

If you and your Card reads the article you will see why irbesartan is

worthless in PA and CCBS not so good either. Assume you got low K

with diuretics.

On May 25, 2008, at 9:40 PM, Carol Christie wrote:

> Hi a

> My BP is averaging 140/75 - the systolic varies from 120 to 160, while

> the diastolic doesn't seem to vary very much, whatever that means...

> Have you had any problems with spiro?

> I am also taking 240 mg verapamil, 150mg irbesartan and 150mg

> efexor(depression/anxiety). I asked the cardio about reducing the

> verapamil, but he said not to. I would like to come off any

> unnecessary

> medications. Indeed if spiro continues to work, I really want to

> get off

> the antidepressant. I feel sure the PA is instrumental in the

> depression/anxiety symptoms.

> Carol

[Guest guest]

How was the DX of depression arrived at?

As fatigue is one of the criteria the Low K is the more likely cause.

The criteria for Dx of depression that uses fatigue must require the

exclusion of the know causes of fatigue.

On May 25, 2008, at 10:53 PM, Valarie wrote:

> Carol, do you feel the Effexor is working well for your anxiety and

> depression?

>

> Val

>

> From: hyperaldosteronism

> [mailto:hyperaldosteronism ] On Behalf Of Carol

> Christie

>

> Hi a

> My BP is averaging 140/75 - the systolic varies from 120 to 160, while

> the diastolic doesn't seem to vary very much, whatever that means...

> Have you had any problems with spiro?

> I am also taking 240 mg verapamil, 150mg irbesartan and 150mg

> efexor(depression/anxiety). I asked the cardio about reducing the

> verapamil, but he said not to. I would like to come off any

> unnecessary

> medications. Indeed if spiro continues to work, I really want to

> get off

> the antidepressant. I feel sure the PA is instrumental in the

> depression/anxiety symptoms.

> Carol

>

>

[Guest guest]

Not sure what estradiol is for but would hold off if possible till Dx

of PA is worked out.

It can raise BP as well. Dr. Weinberger's father first reported this

about 40 years or so ago.

On May 25, 2008, at 11:08 PM, Valarie wrote:

> Oh, Carol, I understand. I can't concentrate worth a damn now. In

> 2001 -

> 02, I was the president of my women's political group. I organized all

> sorts of stuff - teach-ins, speakers, scholarships, etc. I was also

> the

> vice chair of my political party. Doing all that organizing for

> caucuses,

> assemblies, conventions, etc., is a lot of work. I just gave up my

> delegate

> position to the state convention because my nerves cannot tolerate the

> noise, commotion, and crowded conditions. Yeah, I kind of feel a

> bit brain

> damaged.

>

> I'm on 150 mg of spiro and have gone back estradiol. I'm worried if

> the

> progesterone is going to work when I have to use it. I've read that

> spiro

> blocks the effects of progesterone.

>

> Val

>

> From: hyperaldosteronism

> [mailto:hyperaldosteronism ] On Behalf Of Carol

> Christie

> Hello Val

> Thanks for your comment - hearing each other's stories helps

> confirm the

> validity of our own experience. Thanks for all your posts, and I trust

> you get some answers soon. One of the hardest things for me has been

> loss of skills related to organising, planning etc. The effect on my

> brain I find so frustrating. Almost like it's an acquired brain

> injury.

> Carol

>

>

[Guest guest]

Hello Dr Grim

Yes I am the same person you contacted Dr Stowasser about before. The

cardiologist is Dr Nik Nikwan at Greenslopes Hospital. Dr Stowasser did

contact Nikwan after your last email to him re breast cancer and spiro.

Nikwan has worked with Stowasser and Prof Gordon, I understand. In fact

he referred to some research done by Prof Gordon in saying that 50mg

should be the maximum dosage. It would be good to get some clarification

about this.

Thank you

Carol

Clarence Grim wrote:

>

> I cannot imagine a Dr with experience in treating PA being reluctant

> to use more than 50 mg of spiro.

>

> We go up to 400 per day.

>

> I did send a query to Dr. Stowasser in Brisbane about your Drs

> concern and he was trying to track him down to bring him up to date.

> If you can give me his name that will help.

>

> Unless you are a different Aussie with PA.

>

> On May 25, 2008, at 7:38 PM, Carol Christie wrote:

>

> > Since I was diagnosed with PA in 2004, I was prescribed initially 12.5

> > mg per day of spiro and from 2006, 25mg per day. I have recently got

> > agreement from the cardiologist to increase to 50mg - he is very

> > reluctant about it, citing side effects.

> > For the past couple of weeks, I have felt so much better - no episodes

> > of brain fog leading to extreme exhaustion. I almost feel normal!!!

> > I can't help but wonder why I have suffered debilitating symptoms for

> > the last 4 years, if so simple a solution was possible. I have not

> > been

> > able to work, and my quality of life has been poor.

> > I was told not to increase from 50mg per day as that is the maximum

> > dose

> > necessary to blockade all aldosterone receptors in the body.

> > Would really appreciate your comments, Dr Grim and others.

> > Carol (in Australia)

>

>

[Guest guest]

I am certain that Prof Gordon did not say 50 unless he was talking

about men.

I gave a talk there in 1983 when I was the Aust Heart Foundations

international visiting fellow for a year. I talked about early

primary aldo even then and used the same slides I have in my most

recent review which is in our files.

Maybe he misunderstood it as 50 and not 500 as we still go to 400 mg

here if it can be tolerated. If pts can restrict salt it is not

necessary to go so high.

On May 26, 2008, at 1:25 AM, Carol Christie wrote:

> Hello Dr Grim

> Yes I am the same person you contacted Dr Stowasser about before. The

> cardiologist is Dr Nik Nikwan at Greenslopes Hospital. Dr Stowasser

> did

> contact Nikwan after your last email to him re breast cancer and

> spiro.

> Nikwan has worked with Stowasser and Prof Gordon, I understand. In

> fact

> he referred to some research done by Prof Gordon in saying that 50mg

> should be the maximum dosage. It would be good to get some

> clarification

> about this.

> Thank you

> Carol

[Guest guest]

Hi Carol,

Cardiologists deal with the heart and are used to

treating their CHF patients with small doses of spiro,

not the huge doses needed in PA. The adrenal glands

are not their area of expertise and I think we sort of

freak them out. I had decreased my spiro to 75 mg

twice per day but my BP was slowly going up. A few

months ago at my cardio's office it was 146/85 and he

said he might add diazide. I said no, not a good

thing for a person with PA, and had to explain why.

Then he said he could add an ACE inhibitor. I told

him it wouldn't work on me. I had taken him Dr.

Grim's paper a while back but he either didn't read it

or had forgotten what it said. I told him I'd monitor

my pressure at home and up the spiro as needed. He

didn't like that at all because I was already on a

HUGE dose (150 mg per day), his words. I said, not

for PA patients it isn't. I upped the spiro back to

100 mg twice per day and BP responded well, 117/68

this am. I have to agree with Val. It's a sad state

of medical affairs when this group knows more about

our condition than most of our doctors. How's your

K+? Before my diagnosis when my K+ was running low, I

felt the worst that I've ever felt in my life. I

remember telling a co-worker that I thought I was

dying and I was not exaggerating.

a

--- Carol Christie <carolch@...> wrote:

> Hi a

> My BP is averaging 140/75 - the systolic varies from

> 120 to 160, while

> the diastolic doesn't seem to vary very much,

> whatever that means...

> Have you had any problems with spiro?

> I am also taking 240 mg verapamil, 150mg irbesartan

> and 150mg

> efexor(depression/anxiety). I asked the cardio about

> reducing the

> verapamil, but he said not to. I would like to come

> off any unnecessary

> medications. Indeed if spiro continues to work, I

> really want to get off

> the antidepressant. I feel sure the PA is

> instrumental in the

> depression/anxiety symptoms.

> Carol

[Guest guest]

I went off estradiol in Feb because each time I used it, the gripping,

intense anxiety increased. It is not bothering me now. In fact, I feel

better on it than off. I've been using it because my bones are seriously

osteoporotic (from 14 years of undiagnosed HPT) and so far, I am refusing

Foxamax. I guess I'll go off it again so nothing could be interfering. I

didn't note any drop in BP when I stopped in February nor any change when I

resumed on May 7. The only thing that seems better is the sweats are

diminished, but not gone. I don't know if that is from spiro (probably) or

estradiol (probably not). Earlier today, I was pulling weeds and feeling

quite well. It is nearly cold here today. After a while, I developed

weakness, sweats and tremors - same as always. I had to come in and sit.

Even though my BP is very good on 150 mg spiro, there is still something

wrong.

Menopause. 2008 Jan-Feb;15(1):44-50.

CONCLUSIONS: The results suggest that irbesartan and estradiol, when used in

combination, may cause a greater lowering of blood pressure in

postmenopausal hypertensive women. This effect may be mediated via increased

vasodilation and lower aldosterone levels. These results warrant further

testing in larger clinical trials.

PMID: 18182939 [PubMed - indexed for MEDLINE]

Val

From: hyperaldosteronism

[mailto:hyperaldosteronism ] On Behalf Of Clarence Grim

Not sure what estradiol is for but would hold off if possible till Dx

of PA is worked out.

It can raise BP as well. Dr. Weinberger's father first reported this

about 40 years or so ago.

On May 25, 2008, at 11:08 PM, Valarie wrote:

> Oh, Carol, I understand. I can't concentrate worth a damn now. In

> 2001 -

> 02, I was the president of my women's political group. I organized all

> sorts of stuff - teach-ins, speakers, scholarships, etc. I was also

> the

> vice chair of my political party. Doing all that organizing for

> caucuses,

> assemblies, conventions, etc., is a lot of work. I just gave up my

> delegate

> position to the state convention because my nerves cannot tolerate the

> noise, commotion, and crowded conditions. Yeah, I kind of feel a

> bit brain

> damaged.

>

> I'm on 150 mg of spiro and have gone back estradiol. I'm worried if

> the

> progesterone is going to work when I have to use it. I've read that

> spiro

> blocks the effects of progesterone.

>

> Val

>

> From: hyperaldosteronism

<mailto:hyperaldosteronism%40>

> [mailto:hyperaldosteronism

<mailto:hyperaldosteronism%40> ] On Behalf Of Carol

> Christie

> Hello Val

> Thanks for your comment - hearing each other's stories helps

> confirm the

> validity of our own experience. Thanks for all your posts, and I trust

> you get some answers soon. One of the hardest things for me has been

> loss of skills related to organising, planning etc. The effect on my

> brain I find so frustrating. Almost like it's an acquired brain

> injury.

> Carol

>

>

[Guest guest]

Val, I feel better using Efexor than I did using Lexapro. It doesn't

help, though, with the anxiety that comes on with a PA episode. I'm

hoping that if I can feel better with increased dosage of spiro that I

can come off Efexor. Time will tell...

Carol

Valarie wrote:

>

> Carol, do you feel the Effexor is working well for your anxiety and

> depression?

>

> Val

>

> From: hyperaldosteronism

> <mailto:hyperaldosteronism%40>

> [mailto:hyperaldosteronism

> <mailto:hyperaldosteronism%40>] On Behalf Of Carol Christie

>

> Hi a

> My BP is averaging 140/75 - the systolic varies from 120 to 160, while

> the diastolic doesn't seem to vary very much, whatever that means...

> Have you had any problems with spiro?

> I am also taking 240 mg verapamil, 150mg irbesartan and 150mg

> efexor(depression/anxiety). I asked the cardio about reducing the

> verapamil, but he said not to. I would like to come off any unnecessary

> medications. Indeed if spiro continues to work, I really want to get off

> the antidepressant. I feel sure the PA is instrumental in the

> depression/anxiety symptoms.

> Carol

>

>

[Guest guest]

Over and over we hear about " the anxiety that comes on with a PA episode, "

but there is little to nothing in the literature about this issue. I guess

it can't be measured very well.

Val

From: hyperaldosteronism

[mailto:hyperaldosteronism ] On Behalf Of Carol Christie

Val, I feel better using Efexor than I did using Lexapro. It doesn't

help, though, with the anxiety that comes on with a PA episode. I'm

hoping that if I can feel better with increased dosage of spiro that I

can come off Efexor. Time will tell...

Carol

[Guest guest]

I agree with a.....to a point. I am now on 350 mg daily (100 mg at 7 a.m.,

and 3 p.m., and 150 at bedtime). This was an increase made 2 years ago from 100

mg bid when my aldosterone level spiked to 350.........AFTER starting a 6 month

course of Claritin for extreme allergic rhinitis and increased asthma.

I have 2 excellent doctors (my respiratory/internist whose partner diagnosed

the hyperaldostoneism in 1977 when my potassium was below 1), and the young

family practitioner who now helps monitor me. I say that because from my first

visit with her when I told her about the hyperaldosteroneism she has listened to

me, given suggestions, monitored closely with blood draws every 3 months,

consulted with the respiratory doctor, etc. but overall has been an excellent

partner in my care. At this point as long as I " feel " like things are right,

and ALL of my blood levels (potassium, and all basic metabolism levels, etc) are

good, and my hgbA1c is stable (for me this is at 7.1 to 7.2 but I have no

diabetic complications and my insulin doses are 200 units plus daily), both

doctors have the feeling that what I am doing is right based on no

hospitalizations, etc. I am back on Claritin but I added 2.5 mg of prednisone

and my aldosterone level is stable (although agreeably high) at

110-115. My blood pressures are good.

And my husband's cardiologist (who just put hubby on 25 daily of spiro because

of the heart and his pacemaker) was blown away when I said I was pleased to

hear that spiro is now used for heart - I should have the best heart in

Missouri.

It sometimes comes down to knowing your own body most of all - and not asking

......TELLING ...... doctors what you will / will not change in regard to your

care. I " fired " one very excellent endocrinologist after he belittled me for

wanting to be in charge of my care. The only good thing that ever came out of

his mouth was when he admitted " you don't HAVE any metabolism. "

[Guest guest]

We need to be sure each person spells out exactly what they mean by a

PA episode.

Also:

1. What brings it on if anything/

2. How long does it last?

3. Can you stop it if you catch it early?

4. What can you do to make it go away?

5. What has been the past role of BP meds or diuretics on the spells?

6. What do blood tests reveal during or after a spell?

Same for the " anxiety episode "

On May 26, 2008, at 7:50 PM, Valarie wrote:

> Over and over we hear about " the anxiety that comes on with a PA

> episode, "

> but there is little to nothing in the literature about this issue.

> I guess

> it can't be measured very well.

>

> Val

>

> From: hyperaldosteronism

> [mailto:hyperaldosteronism ] On Behalf Of Carol

> Christie

>

> Val, I feel better using Efexor than I did using Lexapro. It doesn't

> help, though, with the anxiety that comes on with a PA episode. I'm

> hoping that if I can feel better with increased dosage of spiro that I

> can come off Efexor. Time will tell...

> Carol

>

>

[Guest guest]

Yes but you have low renin and irb does not work and estradaiol will

increase renin substrate and perhapr renin and then aldo but this has

not been as well studied.

On May 26, 2008, at 4:03 PM, Valarie wrote:

> Menopause. 2008 Jan-Feb;15(1):44-50.

> CONCLUSIONS: The results suggest that irbesartan and estradiol,

> when used in

> combination, may cause a greater lowering of blood pressure in

> postmenopausal hypertensive women. This effect may be mediated via

> increased

> vasodilation and lower aldosterone levels. These results warrant

> further

> testing in larger clinical trials

CE Grim MS, MD

High Blood Pressure Consulting

Clinical Professor of Medicine Medical College of Wisconsin

Board certified in Internal Med, Geriatrics and Hypertension.

Interests: The effect of recent evolutionary forces on high blood

pressure in human populations.

[Guest guest]

Where in MO are you? I grad from U of MO in Columbia a long time ago

and was on faculty from 1970-73. Trained many good Drs how to Dx PA

I hope.

Who first made the DX? I might know him or her.

Take my article to your team as they may have missed it.

On May 27, 2008, at 7:44 AM, Hidy wrote:

> I agree with a.....to a point. I am now on 350 mg daily (100

> mg at 7 a.m., and 3 p.m., and 150 at bedtime). This was an increase

> made 2 years ago from 100 mg bid when my aldosterone level spiked

> to 350.........AFTER starting a 6 month course of Claritin for

> extreme allergic rhinitis and increased asthma.

>

> I have 2 excellent doctors (my respiratory/internist whose partner

> diagnosed the hyperaldostoneism in 1977 when my potassium was below

> 1), and the young family practitioner who now helps monitor me. I

> say that because from my first visit with her when I told her about

> the hyperaldosteroneism she has listened to me, given suggestions,

> monitored closely with blood draws every 3 months, consulted with

> the respiratory doctor, etc. but overall has been an excellent

> partner in my care. At this point as long as I " feel " like things

> are right, and ALL of my blood levels (potassium, and all basic

> metabolism levels, etc) are good, and my hgbA1c is stable (for me

> this is at 7.1 to 7.2 but I have no diabetic complications and my

> insulin doses are 200 units plus daily), both doctors have the

> feeling that what I am doing is right based on no hospitalizations,

> etc. I am back on Claritin but I added 2.5 mg of prednisone and my

> aldosterone level is stable (although agreea! bly hi! gh) at

> 110-115. My blood pressures are good.

>

> And my husband's cardiologist (who just put hubby on 25 daily of

> spiro because of the heart and his pacemaker) was blown away when I

> said I was pleased to hear that spiro is now used for heart - I

> should have the best heart in Missouri.

>

> It sometimes comes down to knowing your own body most of all - and

> not asking .....TELLING ...... doctors what you will / will not

> change in regard to your care. I " fired " one very excellent

> endocrinologist after he belittled me for wanting to be in charge

> of my care. The only good thing that ever came out of his mouth was

> when he admitted " you don't HAVE any metabolism. "

>

>

[Guest guest]

Well, I'm going off it as soon as my cyclical progesterone is done - 6 more

days. Here's an old study, including Dr. Conn himself.:

J Clin Endocrinol Metab. 1977 Dec;45(6):1297-304.

Renin-renin substrate kinetic constants in the plasma of normal and

estrogen-treated humans.

Mc WJ, Cohen EL, Lucas CP, Conn JW.

The renin-renin substrate is constant (Km) and maximal velocity

(Vmax) were determined in the plasmas of normal subjects. The mean Km was

0.7 microgram/ml. Under these conditions, the in vitro reaction of renin

with physiologic concentrations of renin substrate will proceed at only 70%

of its maximal velocity. Following estrogen administration, Km doubled to a

value of 1.3 microgram/ml. Vmas increased by 81%. Analysis of the changes

induced in the in vitro reaction velocity demonstrated that estrogen-induced

acceleration of the renin reaction is dependent upon both an increase in

renin substrate concentration as well as an increase in Vmas. The latter

appears to be quantitatively more important. These findings suggest the

emergence of modifying factors in the renin-renin substrate interaction

following estrogen administration.

PMID: 591623 [PubMed - indexed for MEDLINE]

Val

From: hyperaldosteronism

[mailto:hyperaldosteronism ] On Behalf Of Clarence Grim

Yes but you have low renin and irb does not work and estradaiol will

increase renin substrate and perhapr renin and then aldo but this has

not been as well studied.

[Guest guest]

Ah yes I recall now. Dr. Mc was there after I was and Dr.

Cohen was my mentor as well. Dr. Lucas was there when I was there.

One reason total renin measurements dont give a good assessment of

the Renins state. Renin activity is much better.

On May 28, 2008, at 11:27 AM, Valarie wrote:

> Well, I'm going off it as soon as my cyclical progesterone is done

> - 6 more

> days. Here's an old study, including Dr. Conn himself.:

>

> J Clin Endocrinol Metab. 1977 Dec;45(6):1297-304.

>

>

> Renin-renin substrate kinetic constants in the plasma of normal and

> estrogen-treated humans.

>

> Mc WJ, Cohen EL, Lucas CP, Conn JW.

>

> The renin-renin substrate is constant (Km) and maximal velocity

> (Vmax) were determined in the plasmas of normal subjects. The mean

> Km was

> 0.7 microgram/ml. Under these conditions, the in vitro reaction of

> renin

> with physiologic concentrations of renin substrate will proceed at

> only 70%

> of its maximal velocity. Following estrogen administration, Km

> doubled to a

> value of 1.3 microgram/ml. Vmas increased by 81%. Analysis of the

> changes

> induced in the in vitro reaction velocity demonstrated that

> estrogen-induced

> acceleration of the renin reaction is dependent upon both an

> increase in

> renin substrate concentration as well as an increase in Vmas. The

> latter

> appears to be quantitatively more important. These findings suggest

> the

> emergence of modifying factors in the renin-renin substrate

> interaction

> following estrogen administration.

> PMID: 591623 [PubMed - indexed for MEDLINE]

>

> Val

>

> From: hyperaldosteronism

> [mailto:hyperaldosteronism ] On Behalf Of Clarence Grim

>

> Yes but you have low renin and irb does not work and estradaiol will

> increase renin substrate and perhapr renin and then aldo but this has

> not been as well studied.

>

>

[Guest guest]

Dr Grim, I spoke with my GP about spiro dosage, your comments and my

cardiologist's management of my PA. She has agreed that the dosage of

spiro is too low, and is monitoring my increase in dosage. For a week I

took 50mg per day and am now on 100mg(2x50mg). I had been feeling much

better until yesterday when I felt very weak in the legs and very fatigued.

I have been wondering if you have heard anything from Dr Stowasser.

Carol

Clarence Grim wrote:

>

> I am certain that Prof Gordon did not say 50 unless he was talking

> about men.

>

> I gave a talk there in 1983 when I was the Aust Heart Foundations

> international visiting fellow for a year. I talked about early

> primary aldo even then and used the same slides I have in my most

> recent review which is in our files.

>

> Maybe he misunderstood it as 50 and not 500 as we still go to 400 mg

> here if it can be tolerated. If pts can restrict salt it is not

> necessary to go so high.

>

> On May 26, 2008, at 1:25 AM, Carol Christie wrote:

>

> > Hello Dr Grim

> > Yes I am the same person you contacted Dr Stowasser about before. The

> > cardiologist is Dr Nik Nikwan at Greenslopes Hospital. Dr Stowasser

> > did

> > contact Nikwan after your last email to him re breast cancer and

> > spiro.

> > Nikwan has worked with Stowasser and Prof Gordon, I understand. In

> > fact

> > he referred to some research done by Prof Gordon in saying that 50mg

> > should be the maximum dosage. It would be good to get some

> > clarification

> > about this.

> > Thank you

> > Carol

>

>

[Guest guest]

He sent me a note saying he thought he knew your Dr (the surgeon who

was worried about side effects of sprio that have not been reported)

and was going to talk to him.

He did not come to the Am Soc of HTN meeting 2 weeks ago as he is

prob going to the Int Soc HTN meeting in Berlin in June. I am not

going to that one.

On Jun 3, 2008, at 9:02 AM, Carol Christie wrote:

> Dr Grim, I spoke with my GP about spiro dosage, your comments and my

> cardiologist's management of my PA. She has agreed that the dosage of

> spiro is too low, and is monitoring my increase in dosage. For a

> week I

> took 50mg per day and am now on 100mg(2x50mg). I had been feeling much

> better until yesterday when I felt very weak in the legs and very

> fatigued.

> I have been wondering if you have heard anything from Dr Stowasser.

> Carol

>

> Clarence Grim wrote:

> >

> > I am certain that Prof Gordon did not say 50 unless he was talking

> > about men.

> >

> > I gave a talk there in 1983 when I was the Aust Heart Foundations

> > international visiting fellow for a year. I talked about early

> > primary aldo even then and used the same slides I have in my most

> > recent review which is in our files.

> >

> > Maybe he misunderstood it as 50 and not 500 as we still go to 400 mg

> > here if it can be tolerated. If pts can restrict salt it is not

> > necessary to go so high.

> >

> > On May 26, 2008, at 1:25 AM, Carol Christie wrote:

> >

> > > Hello Dr Grim

> > > Yes I am the same person you contacted Dr Stowasser about

> before. The

> > > cardiologist is Dr Nik Nikwan at Greenslopes Hospital. Dr

> Stowasser

> > > did

> > > contact Nikwan after your last email to him re breast cancer and

> > > spiro.

> > > Nikwan has worked with Stowasser and Prof Gordon, I understand. In

> > > fact

> > > he referred to some research done by Prof Gordon in saying that

> 50mg

> > > should be the maximum dosage. It would be good to get some

> > > clarification

> > > about this.

> > > Thank you

> > > Carol

> >

> >