J. Brian Byrd

Primary Aldosteronism: An Endocrine Society Clinical Practice Guideline AbstractBackground. Primary aldosteronism (PA), a primary adrenal disorder leading to excessive aldosterone production by one or both adrenal glands, is a

New PA Endo guideline is also out by experts @anandvaidya17.bsky.social #Cardiosky @hswapnil.medsky.social doi.org/10.1210/clin...

Efficacy and Side-Effect Profile of Baxdrostat in Patients with Primary Aldosteronism.

A medical adrenalectomy?

ASIs advance - Baxdrostat in primary aldosteronism now www.nejm.org/doi/full/10.... n = 15 single arm trial from @adinaturcu.bsky.social and @astra-zeneca.bsky.social in @nejm.org

~ 25/10 mm Hg BP lowering and impressive aldosterone level drop

#Hypertension #EndoSky

Canadian finerenone is so cheap! In US, insurance does not approve unless you have both CKD and DM. at least that's why they told us why our request fails prior authorizations

Amiloride instead of finerenone unless per FDA label indication would be my general thinking

Dose equivalence of eplerenone seems roughly correct to me

Spironolactone vs Amiloride for Resistant Hypertension This randomized trial assesses whether amiloride is noninferior to spironolactone in reducing home-measured systolic blood pressure among patients with resistant hypertension.

Amiloride getting another look

jamanetwork.com/journals/jam...

However also includes
- hydralazine (🤦🏽‍♂️)
Excludes
- guanfacine (sorry @jbrianbyrd.bsky.social )

Related commentary from @jbrianbyrd.bsky.social and colleagues

academic.oup.com/ajh/article/...

Is Hypertension too important to be left for physicians?

New Support for Old Medications in Resistant Hypertension The term resistant hypertension has been variably applied to patients with high blood pressure (BP) since at least the 1960s.1 Specific definitions have evolved over time to align with advances in tre...

& with this interesting editorial by Dr. Brook (cc: Dr. @jbrianbyrd.bsky.social) & Dr. @jordybc.bsky.social et al too: jamanetwork.com/journals/jam...

@drjmluther.bsky.social actually did speak about it briefly!

I would like to use it in some select patients - also guanfacine!

@jbrianbyrd.bsky.social

old drugs in HT

Plenary at @hypertensioncanada.bsky.social with @drjmluther.bsky.social on new drugs

He starts of with the really old drugs!

#CHC25

Global journey of clonazepam: A) Clonazepam transportation routes and distances. B) API and excipient salt extraction and production. C) Journey through North America.

Global journey of clonazepam: A) Clonazepam transportation routes and distances. B) API and excipient salt extraction and production. C) Journey through North America.

Global journey of clonazepam: A) Clonazepam transportation routes and distances. B) API and excipient salt extraction and production. C) Journey through North America.

Delightful read of the day (with terrible implications)

The journey of clonazepam from API in Guangzhou to the tablet being consumed is 63,162 kms

www.cfp.ca/content/71/4...

From McMaster (school of engineering and family medicine)

h/t Chris Hannah of @theglobeandmail.com

The Na-K Exchange Saves Lives — NephJC This week, we will discuss the SSASS trial. in which a simple switch of table salt with a K-enriched salt works miracles. Is it about the sodium or the potassium?

K issues
#NephJC www.nephjc.com/news/salt-su...
Podcast www.nephjc.com/freelyfilter...

K switch mechanism
pubmed.ncbi.nlm.nih.gov/38081406/ in @ajkd.bsky.social

pubmed.ncbi.nlm.nih.gov/37772757/ from @amjhypertension.bsky.social

journals.physiology.org/doi/full/10....

#WorldHypertensionDay

Spironolactone vs Amiloride for Resistant Hypertension This randomized trial assesses whether amiloride is noninferior to spironolactone in reducing home-measured systolic blood pressure among patients with resistant hypertension.

the amiloride - spironolactone RCT
jamanetwork.com/journals/jam...

PATHWAY-2 trial www.thelancet.com/article/S014...

Lorundrostat RCT www.nejm.org/doi/full/10.... (coming on #NephJC soon)

#WorldHypertensionDay

💬 Today we discuss lorundrostat in the Advanced-HTM @nejm.org article
No excuse to not read it #NephJC #NephSky #MedSky
www.nejm.org/doi/10....

Note that aldosterone escape refers to escape from the effects of aldosterone under some conditions

And aldosterone breakthrough is the term for continued aldosterone production despite renin-angiotensin blockade

Advance-HTN: Return of the systolic order – Lorundrostat’s role in restoring balance — NephJC This week, we will discuss a NEJM trial on uncontrolled hypertension: lorundrostat, an aldosterone synthase inhibitor, aims at the hormonal dark side driving resistance.

Is (hypertensive) resistance really futile?
#NephSky Join us today 5/27/25 9pm EST only on #Bluesky to discuss Lorundrostat, a new Aldosterone Synthase Inhibitor. #NephJC
Learn about it you must! Don't give in to the dark side of uncontrolled HTN.
www.nephjc.com/news/advance-htn-lorundrostat

Salt excreting crocodile!

Here the next entry when @nephmadness.bsky.social revisits animal house!

Deeply honored to learn of my tenure decision at @umich.edu med school today.

Very grateful to all whose confidence in me, investment in me, and work with me made this milestone possible. Excited to continue advancing hypertension research alongside such brilliant colleagues

Organ Trafficking: How Germans Buy New Kidneys in Kenya Germans in need of new kidneys are heading to Kenya to buy one. The donors are frequently suffering from bitter poverty. Behind the scheme is an Israeli whom the authorities have been after for years.

The illegal kidney transplant trade continues

Now centered in Kenya, with donors from Africa, Azerbaijan and elsewhere

Recipients from Western Europe, Russia, and other places

www.spiegel.de/internationa...

With an Indian in the center

#NephSky #PublicHealth

h/t @jbrianbyrd.bsky.social

Lorundrostat Efficacy and Safety in Patients with Uncontrolled Hypertension | NEJM Aldosterone dysregulation contributes to hypertension. Lorundrostat is an aldosterone synthase inhibitor, but data on its efficacy and safety in patients with hypertension are limited. In this mult...

The ASIs have arrived

www.nejm.org/doi/full/10....

Aldosterone synthase inhibitors - first one to finish the phase 3 line

#Lorundrostat #Hypertension

Great talk by @alexchangmd.bsky.social discussing novel antiHTN drugs@nkf-professionals.bsky.social

@drwanpen.bsky.social presents on SGLT2i and blood pressure

@nkf-professionals.bsky.social

Great review of literature on role of diuretics in BP in CKD @spjuraschek.bsky.social

Comparative cardiovascular safety of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis Practitioners should monitor blood pressure and pulse in patients with ADHD treated with any pharmacological intervention, and not stimulants only. Given the short duration of available randomised con...

Effect of ADHD meds on blood pressure

SR in @thelancet.bsky.social Psychiatry that I don’t have access to

www.thelancet.com/journals/lan...

Small BP increase with most meds

But

See the BP lowering effect with guanfacine! @jbrianbyrd.bsky.social

NEJM Editorial Fellow Sarah Gorey, MD (@sarahgorey.bsky.social), summarizes the Original Article “Global Effect of Cardiovascular Risk Factors on Lifetime Estimates.” Read the full article: nej.md/4kS5ZVr

#ACC25 #MedSky #CardioSky @accintouch.bsky.social

Great pearls by @jbrianbyrd.bsky.social in evaluating pts for RDN at #ACC25: 1. confirm uncontrolled HTN with out of office measure (Amb BP monitor); 2. trial spironolactone 1st; 3.
shared decision making key - care team should include HTN specialists beyond those performing the procedure #cardiosky

BP values before and after MVDs. From September 2022 to June 2024, noninvasive and invasive BP measurement was regularly taken multiple times per day with a maximum of four measurements per day which went into analysis. In case of invasive BP measurement, mean values of morning, noon, evening and night were used. (a) After 1st MVD, preop mean systolic 156.2 mmHg and mean diastolic 96.9 mmHg BP values (measured from initial presentation in September 2022 until the 1st MVD) significantly decreased to postop mean systolic 126.9 mmHg and mean diastolic 71.4 mmHg (n = 476 for preop values and n = 74 postop values; mean systolic difference −29.3 ± SEM 2.2 and 95% confidence interval −33.6 to −25.0, mean diastolic difference −25.4 ± SEM 2.1 and 95% confidence interval −29.6 to −21.2). (b) After 2nd MVD, mean systolic 165.3 mmHg and mean diastolic 108.5 mmHg BP values (measured from February 2024 until the 2nd MVD) significantly decreased to postop mean systolic 112.9 mmHg and mean diastolic 62.8 mmHg (n = 11 for preop values and n = 112 postop values; mean systolic difference −52.3 ± SEM 2.9 and 95% confidence interval −58.0 to −46.6, mean diastolic difference −45.7 ± SEM 3.2 and 95% confidence interval −52.1 to −39.3). Unpaired Student's t-test ∗∗∗∗P value < 0.0001. Column bar graph shows mean with standard deviation. x-axis shows systolic and diastolic state preop and postop, y-axis shows BP values in mmHg. preop = preoperative. postop = postoperative. SEM = standard error of the mean.

(My first time hearing of this)

NeuroVascular hypertension from compression of the root entry/exit zone of the ninth/tenth cranial nerves

journals.lww.com/jhypertensio...

Case report with interesting table 1 kf DDx

#Hypertension #NephSky

Dunno that the α blockade with the dual ones is as good as stand alone Doxazosin? Would posit in refractory cases to use them separately

@jbrianbyrd.bsky.social prefers guanfacine before many of these as well (hard to get for me in 🇨🇦 even b4 tariffs kick in)

#NephMadness

I am currently reviewing a paper which makes some extravagant and illogical claims about digital twins. However, I don't want to dismiss the paper because of this. Is there a serious critical analysis of the potential of DTs that can be recommended?

a large yellow letter m with a blue outline ALT: a large yellow letter m with a blue outline

3 hrs until tonite's discussion on characterizing the origins of primary hyperaldosteronism. #NephJC
Did you know...
Conn's syndrome is named after Jerome W. Conn (1907–1994), the American endocrinologist who first described primary aldosteronism at the University of Michigan in 1955.