Happy to see our commentary with @jbrianbyrd.bsky.social suggesting that Angiotensin II should be part of the evaluation of primary hyperaldosteronism. @nu-nephrology.bsky.social @nufeinbergmed.bsky.social www.ahajournals.org/doi/10.1161/...

Dan Batlle & I wrote about testing for primary aldosteronism, bringing a critical lens to the usual approach www.ahajournals.org/doi/full/10....

Woah, it’s possible hydralazine may be (rarely) useful outside of preeclampsia! www.science.org/doi/10.1126/... 🤯 H/t @jbrianbyrd.bsky.social

From @carolyntan.bsky.social This is a work of art Have to agree that amlodipine and gabapentin/pregabalin often lead to heart failure misdiagnosis #MedSky #PharmSky h/t @davidjuurlink.bsky.social and @jbrianbyrd.bsky.social

Yes, MRAs can cause mild hyponatremia. Usually not a major issue but can be a factor. I have not seen severe hyponatremia (eg <125) and use a lot. Aldosterone deficient mice are mildly hyponatremic (inconsistently) Primary aldosteronism is associated with mild hypernatremia

We do see the occasional hyponatremia even with spironolactone (though often attributed to something else and not well documented) cc @drjmluther.bsky.social for more

T4e 5️⃣Primary aldosteronism screening – screen all adults with resistant HTN regardless of potassium level (COR I, LOE B-NR). Continue most antihypertensives except MRA before testing (COR I, LOE C-EO). 📝Is screening worthwhile or should we just be using MRAs earlier? #NephJC

And it looks like it is cleared by the FDA apple.news/AFT61lWmgRfG... The confusion on whether it will actually show numbers or just ‘you may have hypertension’ still persists

To me, It sounds like a PPG sensor analyzing the pulse transit time "Apple Watch use data from the optical heart sensor to analyze how a user’s blood vessels respond to the beats of the heart. The algorithm works passively in the background reviewing data".

The new ⌚️ will have hypertensive notifications This doesn’t seem like a cuffless BP - but more like a notification ‘you may have hypertension, go check your BP’ ? From www.apple.com/newsroom/202... @jordybc.bsky.social @drwanpen.bsky.social @spjuraschek.bsky.social @daichishimbo.bsky.social?

Join us for the #nephjc chat on this topic sooon! cc: Dr. @jbrianbyrd.bsky.social bsky.app/profile/neph...

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

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 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?

& 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

Plenary at @hypertensioncanada.bsky.social with @drjmluther.bsky.social on new drugs He starts of with the really old drugs! #CHC25

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

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

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....#NephJC

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

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

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

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 [email protected]

@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

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

(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?

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.

You know that an awesome discussion just took place, when you walk into a room, and the white board looks like this:

The Aldosterone Paradox: A Skeetutorial:

What's the highest renin you've ever seen? An extreme example of a common issue. Severe hyperreninemia secondary to combination ARB+thiazide. www.ccjm.org/content/91/2... (free) @amyaimei.bsky.social #medsky #nephsky

& Dr. @jbrianbyrd.bsky.social & his colleague did a classic clinical review (2014) of arm position during ABPM: pmc.ncbi.nlm.nih.gov/articles/PMC...

Started off this morning emailing my Senators and Congressman about the NIH and the potential damage being done by unnecessary disruptions. They need to hear from us loud and clear. Constituents matter to them as one of the primary purposes of a politician is to get re-elected (and its their job).

In Michigan the ROI is 244%

What a gem. Thank you for sharing. So much to learn from the fascinating philosophy of science.

Philosophically speaking, if an idea is truly unusual, a paradigm shift, then it probably relies more on intuition than method. In turn, intuition may quietly train itself on disciplined methods, until it no longer does so and it grows strong enough to be bold. Vicious ;-)

Is there any method to identifying unusually bold research ideas worth funding? Or is guessing which bold ideas might matter + be feasible purely intuitive / guesswork?

?!