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J. Brian Byrd

@jbrianbyrd.bsky.social

Blood pressure researcher and cardiologist

695 Posts1441 Follower 608 Folgt

American Journal of Hypertension @amjhypertension.bsky.social · 4mo ago

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...

Daniel Batlle, MD @daniel-batlle.bsky.social · 8mo ago

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/...

J. Brian Byrd @jbrianbyrd.bsky.social · 8mo ago

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

American Heart Association Journals

ahajournals.org

Jordy Cohen @jordybc.bsky.social · 8mo ago

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

Hydralazine inhibits cysteamine dioxygenase to treat preeclampsia and senesce glioblastoma

The decades-old preeclampsia drug hydralazine vasodilates and senesces glioblastoma cells via the same enzyme target, ADO.

science.org

Swapnil Hiremath 🍁🇨🇦@hswapnil.medsky.social · 9mo ago

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

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

Matt Luther, MD MSCI @drjmluther.bsky.social · 10mo ago

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

Swapnil Hiremath 🍁🇨🇦@hswapnil.medsky.social · 10mo ago

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

Nephrology Journal Club @nephjc.bsky.social · 11mo ago

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

Swapnil Hiremath 🍁🇨🇦@hswapnil.medsky.social · 11mo ago

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.

Wanpen Vongpatanasin @drwanpen.bsky.social · 11mo ago

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".

Swapnil Hiremath 🍁🇨🇦@hswapnil.medsky.social · 11mo ago

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.

Sarah Melville @sarahkmels.medsky.network · 11mo ago

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

Nephrology Journal Club@nephjc.bsky.social · 11mo ago

Up next! New AHA/ACC hypertension guidelines #NephJC @ahascience.bsky.social @accintouch.bsky.social

Wanpen Vongpatanasin @drwanpen.bsky.social · last yr.

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

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

doi.org

Swapnil Hiremath 🍁🇨🇦@hswapnil.medsky.social · last yr.

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

Wanpen Vongpatanasin @drwanpen.bsky.social · last yr.

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

@grahamabra.bsky.social · last yr.

Amiloride getting another look jamanetwork.com/journals/jam...

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.

jamanetwork.com

Swapnil Hiremath 🍁🇨🇦@hswapnil.medsky.social · last yr.

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

American Journal of Hypertension @amjhypertension.bsky.social · last yr.

Related commentary from @jbrianbyrd.bsky.social and colleagues academic.oup.com/ajh/article/... Is Hypertension too important to be left for physicians?

Hypertension Is Too Important for Healthcare Professionals Alone to Try and Solve

High blood pressure (BP) is the leading risk factor for global morbidity and mortality.1,2 Despite decades of intense public health efforts and the widesca

academic.oup.com

American Journal of Hypertension@amjhypertension.bsky.social · last yr.

Factors Associated With Discussing High Blood Pressure Readings in Clinical Notes (often not discussed at all!) 🔗 academic.oup.com/ajh/article/... 🔓 #EditorsChoice #Free #OpenAccess

Sarah Melville @sarahkmels.medsky.network · last yr.

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

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...

jamanetwork.com

Swapnil Hiremath 🍁🇨🇦@hswapnil.medsky.social · last yr.

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

Swapnil Hiremath 🍁🇨🇦@hswapnil.medsky.social · last yr.

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

Swapnil Hiremath 🍁🇨🇦@hswapnil.medsky.social · last yr.

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.

Swapnil Hiremath 🍁🇨🇦@hswapnil.medsky.social · last yr.

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 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?

nephjc.com

Swapnil Hiremath 🍁🇨🇦@hswapnil.medsky.social · last yr.

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

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.

jamanetwork.com

Nephrology Journal Club @nephjc.bsky.social · last yr.

💬 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....

J. Brian Byrd @jbrianbyrd.bsky.social · last yr.

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

Nephrology Journal Club@nephjc.bsky.social · last yr.

Aldosterone escape effect: Classic RAAS blockers can’t fully shut down aldosterone production. Braxdrostat in the BrightHTN showed SBP reduction, PRA suppresion and no cortisol suppresion #NephJC @nephmadness.bsky.social 2025

Nephrology Journal Club @nephjc.bsky.social · last yr.

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

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.

nephjc.com

Swapnil Hiremath 🍁🇨🇦@hswapnil.medsky.social · last yr.

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

c0nc0rdance@c0nc0rdance.bsky.social · last yr.

American crocodiles (Crocodylus acutus) are native to south Florida & tropical areas bordering the Gulf of Mexico. This photo by 'q phia' @ Flickr shows one displaying their impressive teefs. Adults have the ability to excrete salt from lingual glands, letting them thrive in saline/brackish water.

J. Brian Byrd @jbrianbyrd.bsky.social · last yr.

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

Swapnil Hiremath 🍁🇨🇦@hswapnil.medsky.social · last yr.

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

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.

spiegel.de