iiinova — where your digital self keeps evolving

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American Journal of Hypertension @amjhypertension.bsky.social · 08/04/2026

Congratulations to Drs Daria V. Ilatovskaya and Jordana Cohen on being awarded the 2026 John H. Laragh Research award! academic.oup.com/ajh/pages/jo...

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Daniel Batlle, MD @daniel-batlle.bsky.social · 24/12/2025

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/...

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J. Brian Byrd @jbrianbyrd.bsky.social · 22/12/2025

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

ahajournals.org

American Heart Association Journals

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 04/11/2025

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

$Description of a prescription cascade, when an initial prescription for pregabalin or amlodipine causes leg oedema leading to addition of furosemide which causes urinary incontinence. This leads to a RX for Solifenacin which causes cognitive decline and a prescription for Don Pascale. The subsequent anorexia and an insomnia leads to mirtazapine prescription and a hip fracture from a fall. This of course leads to many other cascades, including delirium, haloperidol and levodopa, risedronate, and pantoprazole, or iron and constipation with peg.$

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Matt Luther, MD MSCI @drjmluther.bsky.social · 16/10/2025

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

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 16/10/2025

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

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Nephrology Journal Club @nephjc.bsky.social · 17/09/2025

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

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 12/09/2025

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

Starting next week, Apple’s new hypertension notification feature will be coming to Watch Series 9 and later and Apple Watch Ultra 2 and later with the launch of watchOS 26. That’s according to an emailed statement from Apple spokesperson Zaina Khachadourian saying the feature that monitors blood pressure has been cleared by the FDA.
Apple’s new hypertension notifications — announced Tuesday alongside the new Apple Watch SE3, Series 11, and Ultra 3 — use data from the watches’ existing optical heart sensor to “analyze how a user’s blood vessels respond to the beats of the heart.” An algorithm will review this data over a 30 day period and notify users if it detects signs of high blood pressure.

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Wanpen Vongpatanasin @drwanpen.bsky.social · 09/09/2025

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".

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 09/09/2025

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?

Hypertension Notifications

Building on its suite of advanced health features, Apple Watch Series 11 introduces groundbreaking hypertension notifications, which can alert users if signs of chronic high blood pressure — or hypertension — are detected.5 Hypertension is the leading modifiable risk factor for heart attack, stroke, and kidney disease, and impacts approximately 1.3 billion adults globally. It is frequently undiagnosed because it often has no symptoms, many people do not see a doctor regularly, and even during a clinical visit, it can be easily missed with a single measurement.
Hypertension notifications on 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 over 30-day periods, and will notify users if it detects consistent signs of hypertension. These notifications provide users with valuable insights into their health as it relates to this widespread condition simply by wearing their Apple Watch, so they can begin making potentially lifesaving behavioral changes, or start treatment to reduce their risk of serious, long-term health events.
Replay video: Apple Watch Series 11 Hypertension Notifications

Hypertension notifications use data from the optical heart sensor on Apple Watch to analyze how a user’s blood vessels respond to the beats of the heart.
Like all of Apple’s health features, hypertension notifications are grounded in rigorous scientific validation. The feature was developed with advanced machine learning and training data from multiple studies totaling over 100,000 participants. Its performance was then validated in a clinical study of over 2,000 participants. While hypertension notifications will not detect all instances of hypertension, with the reach of Apple Watch, the feature is expected to notify over 1 million people with undiagnosed hypertension within the first year.

Hypertension notifications use data from the optical heart sensor on Apple Watch to analyze how a user’s blood vessels respond to the beats of the heart.
Like all of Apple’s health features, hypertension notifications are grounded in rigorous scientific validation. The feature was developed with advanced machine learning and training data from multiple studies totaling over 100,000 participants. Its performance was then validated in a clinical study of over 2,000 participants. While hypertension notifications will not detect all instances of hypertension, with the reach of Apple Watch, the feature is expected to notify over 1 million people with undiagnosed hypertension within the first year.
“Hypertension is the leading preventable cause of heart attack and stroke, yet millions remain undiagnosed,” said Harlan Krumholz, MD, SM, cardiologist and scientist at Yale University and Yale New Haven Hospital. “Making accurate detection easy and part of daily life can help people get care earlier and prevent avoidable harm.”
A user’s iPhone and Apple Watch Series 11 show “Possible Hypertension” and offer more details.
Hypertension notifications were developed with advanced machine learning and training data from multiple studies totaling over 100,000 participants.
If users receive a hypertension notification, it is recommended that they log their blood pressure for seven days using a third-party blood pressure cuff and share the results with their provider at their next visit, which is consistent with the latest American Heart Association guidelines for the diagnosis and management of hypertension.
Clearance for hypertension notifications from the FDA and other regulators is expected soon, and the feature will be available in more than 150 countries and regions — including the U.S. and the EU — this month. Hypertension notifications will be available on Apple Watch Series 9 and later, and Apple Watch Ultra 2 and later, with watchOS 26.

Hypertension Notifications

Hypertension notifications use data from the optical heart sensor on Apple Watch to analyze how a user’s blood vessels respond to the beats of the heart.
Like all of Apple’s health features, hypertension notifications are grounded in rigorous scientific validation. The feature was developed with advanced machine learning and training data from multiple studies totaling over 100,000 participants. Its performance was then validated in a clinical study of over 2,000 participants. While hypertension notifications will not detect all instances of hypertension, with the reach of Apple Watch, the feature is expected to notify over 1 million people with undiagnosed hypertension within the first year.
“Hypertension is the leading preventable cause of heart attack and stroke, yet millions remain undiagnosed,” said Harlan Krumholz, MD, SM, cardiologist and scientist at Yale University and Yale New Haven Hospital. “Making accurate detection easy and part of daily life can help people get care earlier and prevent avoidable harm.”
A user’s iPhone and Apple Watch Series 11 show “Possible Hypertension” and offer more details.
Hypertension notifications were developed with advanced machine learning and training data from multiple studies totaling over 100,000 participants.
If users receive a hypertension notification, it is recommended that they log their blood pressure for seven days using a third-party blood pressure cuff and share the results with their provider at their next visit, which is consistent with the latest American Heart Association guidelines for the diagnosis and management of hypertension.
Clearance for hypertension notifications from the FDA and other regulators is expected soon, and the feature will be available in more than 150 countries and regions — including the U.S. and the EU — this month. Hypertension notifications will be available on Apple Watch Series 9 and later, and Apple Watch Ultra 2 and later, with watchOS 26.

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Sarah Melville @sarahkmels.medsky.network · 04/09/2025

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

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 14/07/2025

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

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Wanpen Vongpatanasin @drwanpen.bsky.social · 08/07/2025

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

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 26/06/2025

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

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 29/05/2025

@drjmluther.bsky.social actually did speak about it briefly! I would like to use it in some select patients - also guanfacine! @jbrianbyrd.bsky.social

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 29/05/2025

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

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 29/05/2025

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

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

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 22/05/2025

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

nephjc.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?

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Nephrology Journal Club @nephjc.bsky.social · 28/05/2025

💬 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....

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J. Brian Byrd @jbrianbyrd.bsky.social · 28/05/2025

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

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Nephrology Journal Club @nephjc.bsky.social · 27/05/2025

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

nephjc.com

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.

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 16/05/2025

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

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J. Brian Byrd @jbrianbyrd.bsky.social · 16/05/2025

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

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 26/04/2025

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

spiegel.de

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.

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Wanpen Vongpatanasin @drwanpen.bsky.social · 12/04/2025

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

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Wanpen Vongpatanasin @drwanpen.bsky.social · 12/04/2025

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

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NEJM.org @nejm.org · 31/03/2025

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

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Heather Gornik @heatherlgornik.bsky.social · 30/03/2025

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

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 18/03/2025

(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

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.

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 04/03/2025

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

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Stephen Senn @stephensenn.bsky.social · 15/02/2025

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?

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Nephrology Journal Club @nephjc.bsky.social · 11/02/2025

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.

media.tenor.com

a large yellow letter m with a blue outline

ALT: a large yellow letter m with a blue outline

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Nephgirlsketches @nephgirlsketch.bsky.social · 08/02/2025

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

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Josh Leisring @joshleisring.bsky.social · 02/02/2025

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

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Jeremy Berg @jeremymberg.bsky.social · 23/01/2025

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).

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Tim Triche, Jr.🔰 @timtriche.bsky.social · 23/01/2025

In Michigan the ROI is 244%

Every dollar invested in NIH yields an average of 244% return on investment in Michigan, and this is BEFORE considering the value of discoveries.

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Georgeta Vaidean @georgeta.bsky.social · 23/01/2025

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

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Georgeta Vaidean @georgeta.bsky.social · 23/01/2025

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 ;-)

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J. Brian Byrd @jbrianbyrd.bsky.social · 22/01/2025

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?

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