Re: internist recommends no avs due invasive/risky as low dose spriro sufficient

[Guest guest]

Barbara, I would certainly be inclined to listen to your internist. If you're

happy with medical treatment there is no reason to continue to AVS and beyond.

You might even find you can keep your BP where it needs to be w/o spiro with

DASH and low NA! (He could do a urine test to see where you are with K and NA.)

Another trial to closer verify PA would be to back off the Ramipril, I believe

it is an ACE inhibiter and they are not effective in PA. (They work off renin

so in your case there is nothing to work on!) Are you on any other meds?

>

> after 18 months of Ramipril/hctz, I was tested for ARR and came back at 165.

Report said " Renin is suppressed while aldo is within the normal physiological

range. Results compatible with PA or beta blocker administration. " (had never

taken beta blockers) Was put on 25mg of Spiro. BP went down to 120/80 or below

daytime. During night would go to 93/64.. would wake up in the night with 2

fingers numb. Reduced to 12.5 mg per day...still pretty good...may go as high

as 138/78 coming off evening shift at work. Internist says not to bother with

AVS or surgery as AVS risky and surgery no guarantee and low spiro seems to do a

pretty good job. Says will have to take it for life (now 56). Never had 24 hr

urine etc done. K had dropped to 3.0 while on HCTZ. PA is being assumed since

Spiro is working. Should I leave well enough alone? How carcinogenic is Spiro

for life? What are the odds of a malignant cause of PA?

>

[Guest guest]

Were you taking Ramipril/hctz when they did the blood tests for ARR? Both meds

affect the outcome of ARR. Hctz can increase renin and lower and increase aldo.

Ramipril can increase renin and lower aldo.

While in your case it may not change DX it does tell you if your dr is up to

speed on testing for PA.

>

> after 18 months of Ramipril/hctz, I was tested for ARR and came back at 165.

Report said " Renin is suppressed while aldo is within the normal physiological

range. Results compatible with PA or beta blocker administration. " (had never

taken beta blockers) Was put on 25mg of Spiro. BP went down to 120/80 or below

daytime. During night would go to 93/64.. would wake up in the night with 2

fingers numb. Reduced to 12.5 mg per day...still pretty good...may go as high

as 138/78 coming off evening shift at work. Internist says not to bother with

AVS or surgery as AVS risky and surgery no guarantee and low spiro seems to do a

pretty good job. Says will have to take it for life (now 56). Never had 24 hr

urine etc done. K had dropped to 3.0 while on HCTZ. PA is being assumed since

Spiro is working. Should I leave well enough alone? How carcinogenic is Spiro

for life? What are the odds of a malignant cause of PA?

>

[Guest guest]

I was taken off HCTZ a year ago due low K and they doubled Ramipril to 20mg but

did not work at all. Dropped the Ramipril in October when they switched me to

Spiro based on the ARR result of 165. Now taking Spiro only 12.5 mg each

morning.

> >

> > after 18 months of Ramipril/hctz, I was tested for ARR and came back at 165.

Report said " Renin is suppressed while aldo is within the normal physiological

range. Results compatible with PA or beta blocker administration. " (had never

taken beta blockers) Was put on 25mg of Spiro. BP went down to 120/80 or below

daytime. During night would go to 93/64.. would wake up in the night with 2

fingers numb. Reduced to 12.5 mg per day...still pretty good...may go as high

as 138/78 coming off evening shift at work. Internist says not to bother with

AVS or surgery as AVS risky and surgery no guarantee and low spiro seems to do a

pretty good job. Says will have to take it for life (now 56). Never had 24 hr

urine etc done. K had dropped to 3.0 while on HCTZ. PA is being assumed since

Spiro is working. Should I leave well enough alone? How carcinogenic is Spiro

for life? What are the odds of a malignant cause of PA?

> >

>

[Guest guest]

Was off HCTZ for 6 months and had stopped Ramipril 2 days prior to

testing...Renin was <2.0 ng/L and Aldo was 330 pmol/L

> >

> > after 18 months of Ramipril/hctz, I was tested for ARR and came back at 165.

Report said " Renin is suppressed while aldo is within the normal physiological

range. Results compatible with PA or beta blocker administration. " (had never

taken beta blockers) Was put on 25mg of Spiro. BP went down to 120/80 or below

daytime. During night would go to 93/64.. would wake up in the night with 2

fingers numb. Reduced to 12.5 mg per day...still pretty good...may go as high

as 138/78 coming off evening shift at work. Internist says not to bother with

AVS or surgery as AVS risky and surgery no guarantee and low spiro seems to do a

pretty good job. Says will have to take it for life (now 56). Never had 24 hr

urine etc done. K had dropped to 3.0 while on HCTZ. PA is being assumed since

Spiro is working. Should I leave well enough alone? How carcinogenic is Spiro

for life? What are the odds of a malignant cause of PA?

> >

>

[Guest guest]

Excellent, I'm still impressed! Has he got your K under control or is it still

low? Are you DASHing? Low sodium V8? Spot or 24hr urine to verify? In my

case they started me on a low dose of Spiro and left me on 7 BP meds and a K

suppl (took 6 months and K getting to 5.2 for them to wake up!) BP resolved

immediately but it took 10 months for everything else to resolve. We thought

alot was due to NA as measured in urine. In reading I have done since, I'm not

sure but that circulating aldosterone was a contributing factor. Keep at it,

you're close, IMHO.

> > >

> > > after 18 months of Ramipril/hctz, I was tested for ARR and came back at

165. Report said " Renin is suppressed while aldo is within the normal

physiological range. Results compatible with PA or beta blocker

administration. " (had never taken beta blockers) Was put on 25mg of Spiro. BP

went down to 120/80 or below daytime. During night would go to 93/64.. would

wake up in the night with 2 fingers numb. Reduced to 12.5 mg per day...still

pretty good...may go as high as 138/78 coming off evening shift at work.

Internist says not to bother with AVS or surgery as AVS risky and surgery no

guarantee and low spiro seems to do a pretty good job. Says will have to take

it for life (now 56). Never had 24 hr urine etc done. K had dropped to 3.0

while on HCTZ. PA is being assumed since Spiro is working. Should I leave well

enough alone? How carcinogenic is Spiro for life? What are the odds of a

malignant cause of PA?

> > >

> >

>

[Guest guest]

If you have read my evolution. Article you wi see u have not yet reached what I define as Group hyperaldo and are in the stage I aCall personal aosteronism. If you are not Dashing to the max yet you may even be able to take less Spiro. But 12.5 is a very low dose ESP if not DASHING to the max. Kudos to your Internist. We should add his. AME to our list Aldosterone literate drs. If you have not taken him my evol article I suspect he will enjoy reading it. Remind him I trained with Dr Conn. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Mar 18, 2012, at 7:14, Barbara <kitkit2005@...> wrote:

after 18 months of Ramipril/hctz, I was tested for ARR and came back at 165. Report said "Renin is suppressed while aldo is within the normal physiological range. Results compatible with PA or beta blocker administration." (had never taken beta blockers) Was put on 25mg of Spiro. BP went down to 120/80 or below daytime. During night would go to 93/64.. would wake up in the night with 2 fingers numb. Reduced to 12.5 mg per day...still pretty good...may go as high as 138/78 coming off evening shift at work. Internist says not to bother with AVS or surgery as AVS risky and surgery no guarantee and low spiro seems to do a pretty good job. Says will have to take it for life (now 56). Never had 24 hr urine etc done. K had dropped to 3.0 while on HCTZ. PA is being assumed since Spiro is working. Should I leave well enough alone? How carcinogenic is Spiro for life? What are the odds of a malignant cause of PA?

[Guest guest]

Ah yes and do we have Barbaras story in our files. Still evolving of course. Risk of cancer in the adrenal is very low. I have only seen one in my lifetime. It was 3 cm in size when discovered. Indee we thought is was a pheo until renin Aldo's came baxkMay your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Mar 18, 2012, at 8:22, <jclark24p@...> wrote:

Barbara, I would certainly be inclined to listen to your internist. If you're happy with medical treatment there is no reason to continue to AVS and beyond. You might even find you can keep your BP where it needs to be w/o spiro with DASH and low NA! (He could do a urine test to see where you are with K and NA.) Another trial to closer verify PA would be to back off the Ramipril, I believe it is an ACE inhibiter and they are not effective in PA. (They work off renin so in your case there is nothing to work on!) Are you on any other meds?

>

> after 18 months of Ramipril/hctz, I was tested for ARR and came back at 165. Report said "Renin is suppressed while aldo is within the normal physiological range. Results compatible with PA or beta blocker administration." (had never taken beta blockers) Was put on 25mg of Spiro. BP went down to 120/80 or below daytime. During night would go to 93/64.. would wake up in the night with 2 fingers numb. Reduced to 12.5 mg per day...still pretty good...may go as high as 138/78 coming off evening shift at work. Internist says not to bother with AVS or surgery as AVS risky and surgery no guarantee and low spiro seems to do a pretty good job. Says will have to take it for life (now 56). Never had 24 hr urine etc done. K had dropped to 3.0 while on HCTZ. PA is being assumed since Spiro is working. Should I leave well enough alone? How carcinogenic is Spiro for life? What are the odds of a malignant cause of PA?

>

[Guest guest]

Francis, while you are ofcourse right to be 100% accurate I would make no

assumption re: the doctor's knowledge based on it. Infact if you refer to the

" Hypertension Primer " you will see the recommendation is: " Nevertheless, for

practical reasons, ARR is most often measured with paitents remaining on

therapy. A high ARR observed during ACE, ARB or diuretic use is even more

suspicious for aldosterone excess because the medications tend to lower ARR by

raising PRA and lowering aldosterone. " (They had already stopped MCBs) If my

ARR came back at 150+ and my first choice was MCB & DASH I would stop there!

If you want to know your doctor's experience I recommend you ask them. In im

experience, most will be honest with you and you can soon identify the ones that

aren't with the help of this group!

> >

> > after 18 months of Ramipril/hctz, I was tested for ARR and came back at 165.

Report said " Renin is suppressed while aldo is within the normal physiological

range. Results compatible with PA or beta blocker administration. " (had never

taken beta blockers) Was put on 25mg of Spiro. BP went down to 120/80 or below

daytime. During night would go to 93/64.. would wake up in the night with 2

fingers numb. Reduced to 12.5 mg per day...still pretty good...may go as high

as 138/78 coming off evening shift at work. Internist says not to bother with

AVS or surgery as AVS risky and surgery no guarantee and low spiro seems to do a

pretty good job. Says will have to take it for life (now 56). Never had 24 hr

urine etc done. K had dropped to 3.0 while on HCTZ. PA is being assumed since

Spiro is working. Should I leave well enough alone? How carcinogenic is Spiro

for life? What are the odds of a malignant cause of PA?

> >

>

[Guest guest]

Please read my evolution of PA and take to your team. When doubling Ram did not work they should have said Ahha PA. CE Grim MD On Mar 18, 2012, at 10:56 AM, Barbara wrote: I was taken off HCTZ a year ago due low K and they doubled Ramipril to 20mg but did not work at all. Dropped the Ramipril in October when they switched me to Spiro based on the ARR result of 165. Now taking Spiro only 12.5 mg each morning. > > > > after 18 months of Ramipril/hctz, I was tested for ARR and came back at 165. Report said "Renin is suppressed while aldo is within the normal physiological range. Results compatible with PA or beta blocker administration." (had never taken beta blockers) Was put on 25mg of Spiro. BP went down to 120/80 or below daytime. During night would go to 93/64.. would wake up in the night with 2 fingers numb. Reduced to 12.5 mg per day...still pretty good...may go as high as 138/78 coming off evening shift at work. Internist says not to bother with AVS or surgery as AVS risky and surgery no guarantee and low spiro seems to do a pretty good job. Says will have to take it for life (now 56). Never had 24 hr urine etc done. K had dropped to 3.0 while on HCTZ. PA is being assumed since Spiro is working. Should I leave well enough alone? How carcinogenic is Spiro for life? What are the odds of a malignant cause of PA? > > >

[Guest guest]

And the normal values for your lab are?CE Grim MDOn Mar 18, 2012, at 11:01 AM, Barbara wrote: Was off HCTZ for 6 months and had stopped Ramipril 2 days prior to testing...Renin was <2.0 ng/L and Aldo was 330 pmol/L > > > > after 18 months of Ramipril/hctz, I was tested for ARR and came back at 165. Report said "Renin is suppressed while aldo is within the normal physiological range. Results compatible with PA or beta blocker administration." (had never taken beta blockers) Was put on 25mg of Spiro. BP went down to 120/80 or below daytime. During night would go to 93/64.. would wake up in the night with 2 fingers numb. Reduced to 12.5 mg per day...still pretty good...may go as high as 138/78 coming off evening shift at work. Internist says not to bother with AVS or surgery as AVS risky and surgery no guarantee and low spiro seems to do a pretty good job. Says will have to take it for life (now 56). Never had 24 hr urine etc done. K had dropped to 3.0 while on HCTZ. PA is being assumed since Spiro is working. Should I leave well enough alone? How carcinogenic is Spiro for life? What are the odds of a malignant cause of PA? > > >

[Guest guest]

Many that have PA don't get Dx because Dr are not testing by guide lines. Since

one can not say how meds change renin and aldo best to do as Endocrine Society's

Guidelines say to. Or better yet go Dr Grim's guidelines.

I have asked many VA Drs about the possibility of having PA. None have given a

good response. Am told that tumor is very commom not that when found testing

should be done to see in it is making hormones. As to my ARP test have been told

meds do not change it that much.

> > >

> > > after 18 months of Ramipril/hctz, I was tested for ARR and came back at

165. Report said " Renin is suppressed while aldo is within the normal

physiological range. Results compatible with PA or beta blocker

administration. " (had never taken beta blockers) Was put on 25mg of Spiro. BP

went down to 120/80 or below daytime. During night would go to 93/64.. would

wake up in the night with 2 fingers numb. Reduced to 12.5 mg per day...still

pretty good...may go as high as 138/78 coming off evening shift at work.

Internist says not to bother with AVS or surgery as AVS risky and surgery no

guarantee and low spiro seems to do a pretty good job. Says will have to take

it for life (now 56). Never had 24 hr urine etc done. K had dropped to 3.0

while on HCTZ. PA is being assumed since Spiro is working. Should I leave well

enough alone? How carcinogenic is Spiro for life? What are the odds of a

malignant cause of PA?

> > >

> >

>

[Guest guest]

You are the opposite of what she was saying. She had an ARR of 165 and you even

mentioned that both meds she talked about would raise renin. If you can

remember your high school math you will remember if you increase the denomintor

you reduce the result so there should be no question that the result of the test

is positive for PA.

My guess is most doctors would not risk modifying meds if they don't have to.

If the results were negative then further testing would be warrented. Her

doctor is right, He tested, he cme to a conclusion of PA, he started treatment,

it worked! Although I bet on PA who cares what you call it!

> > > >

> > > > after 18 months of Ramipril/hctz, I was tested for ARR and came back at

165. Report said " Renin is suppressed while aldo is within the normal

physiological range. Results compatible with PA or beta blocker

administration. " (had never taken beta blockers) Was put on 25mg of Spiro. BP

went down to 120/80 or below daytime. During night would go to 93/64.. would

wake up in the night with 2 fingers numb. Reduced to 12.5 mg per day...still

pretty good...may go as high as 138/78 coming off evening shift at work.

Internist says not to bother with AVS or surgery as AVS risky and surgery no

guarantee and low spiro seems to do a pretty good job. Says will have to take

it for life (now 56). Never had 24 hr urine etc done. K had dropped to 3.0

while on HCTZ. PA is being assumed since Spiro is working. Should I leave well

enough alone? How carcinogenic is Spiro for life? What are the odds of a

malignant cause of PA?

> > > >

> > >

> >

>

[Guest guest]

You are the opposite of what she was saying. She had an ARR of 165 and you even

mentioned that both meds she talked about would raise renin. If you can

remember your high school math you will remember if you increase the denomintor

you reduce the result so there should be no question that the result of the test

is positive for PA.

My guess is most doctors would not risk modifying meds if they don't have to.

If the results were negative then further testing would be warrented. Her

doctor is right, He tested, he cme to a conclusion of PA, he started treatment,

it worked! Although I bet on PA who cares what you call it!

> > > >

> > > > after 18 months of Ramipril/hctz, I was tested for ARR and came back at

165. Report said " Renin is suppressed while aldo is within the normal

physiological range. Results compatible with PA or beta blocker

administration. " (had never taken beta blockers) Was put on 25mg of Spiro. BP

went down to 120/80 or below daytime. During night would go to 93/64.. would

wake up in the night with 2 fingers numb. Reduced to 12.5 mg per day...still

pretty good...may go as high as 138/78 coming off evening shift at work.

Internist says not to bother with AVS or surgery as AVS risky and surgery no

guarantee and low spiro seems to do a pretty good job. Says will have to take

it for life (now 56). Never had 24 hr urine etc done. K had dropped to 3.0

while on HCTZ. PA is being assumed since Spiro is working. Should I leave well

enough alone? How carcinogenic is Spiro for life? What are the odds of a

malignant cause of PA?

> > > >

> > >

> >

>