What's the Dose for Bilateral Hypertension?

With primary aldosteroneism, even if everything else was the same, there's increased adverse cardiac and kidney events. Normally we start at 12 and a half or 25 and then we go up to 50. I'm not usually going much higher than that. In patients with bilateral hyperplasia, it's more difficult. This might be somebody that you would push the dose up to 100 milligrams. You're going to get gynecomastia in men, almost guaranteed. At that high dose, you actually inhibit aldose enthase. So you actually block the aldosterone production, which in these patients might be a benefit.