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Superselective adrenal arterial embolization for primary aldosteronism without lateralized aldosterone secretion: an efficacy and safety, proof-of-principle study

Hypertension Research volume 46, pages 1297–1310 (2023)Cite this article

Abstract

Superselective adrenal arterial embolization (SAAE) appears to be beneficial in primary aldosteronism (PA) patients with lateralized aldosterone secretion (unilateral PA). As confirmed by adrenal vein sampling (AVS), nearly 40% of PA patients would be PA without lateralized aldosterone secretion (bilateral PA). We aimed to investigate the efficacy and safety of SAAE on bilateral PA. We identified 171 bilateral PA patients from 503 PA patients who completed AVS. Thirty-eight bilateral PA patients received SAAE, and 31 completed a median 12-month clinical follow-up. The blood pressure and biochemical improvements of these patients were carefully analyzed. 34% of patients were identified as bilateral PA. Plasma aldosterone concentration, plasma renin activity, and aldosterone/renin ratio (ARR) were significantly improved 24-h after SAAE. SAAE was associated with 38.7% and 58.6% of complete/partial clinical and biochemical success within a median 12-month follow-up. A significant reduction in left ventricular hypertrophy was shown in patients who obtained complete biochemical success compared with partial/absent biochemical success. SAAE was associated with a more apparent nighttime blood pressure reduction than daytime blood pressure reduction in patients with complete biochemical success. No major adverse safety events related to SAAE were reported during the intraoperative, postoperative, and follow-up periods. SAAE was associated with blood pressure and biochemical improvements in part of bilateral PA and appeared safe. The biochemistry success was accompanied by improved cardiac remodeling and a more prominent decrease in nocturnal blood pressure. This study was part of a trial registered with the Chinese Clinical Trial Registry, number ChiCTR2100047689.

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Funding

Funding

The present study was funded by the National Natural Science Foundation of China (81960088).

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  1. These authors contributed equally: Jian Qiu and Ning Li.

Authors and Affiliations

  1. Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China

    Jian Qiu, Ning Li, Hong-Liang Xiong, Jiao Yang, Yun-De Li, Chen-Kai Hu, Ze-Qun Lai, Ning-Peng Liang, Hong-Jin Zhang & Yi-Fei Dong

  2. Department of Cardiology, Fuwai Hospital, Beilishi Road 167, Xicheng District, Beijing, China

    Xiong-Jing Jiang

  3. Key Laboratory of Molecular Biology in Jiangxi Province, Nanchang, Jiangxi, China

    Yi-Fei Dong

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Qiu, J., Li, N., Xiong, HL. et al. Superselective adrenal arterial embolization for primary aldosteronism without lateralized aldosterone secretion: an efficacy and safety, proof-of-principle study. Hypertens Res 46, 1297–1310 (2023). https://doi.org/10.1038/s41440-023-01236-8

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