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A controlled trial of percutaneous adrenal arterial embolization for hypertension in patients with idiopathic hyperaldosteronism

Hypertension Research volume 47, pages 311–321 (2024)Cite this article

A Comment to this article was published on 12 October 2023

Abstract

Our prior study has suggested that percutaneous superselective adrenal arterial embolization (SAAE) with ethanol reduces blood pressure in patients with primary aldosteronism. This study aimed to compare the efficacy of SAAE with mineralocorticoid receptor antagonists (MRA) in treating patients with idiopathic hyperaldosteronism. In this prospective, randomized, controlled trial, we randomly assigned patients with idiopathic hyperaldosteronism in a 1:1 ratio to undergo SAAE (n = 29) or receive MRA (n = 30) treatment. The primary endpoint was the change in mean 24-hour ambulatory systolic blood pressure at 6 months. The secondary endpoints included changes in office blood pressure, home blood pressure, correction of aldosterone-to-renin ratio, and adverse events at 6 months. The mean change in 24-h ambulatory systolic blood pressure from baseline to 6-month follow-up was significantly different between the two groups (−8.4 mmHg; 95% confidence interval, −15.2 to −2.1 mmHg; P < 0.01). Office, home, and ambulatory blood pressure reduction at 6 months was more pronounced in the SAAE group than the MRA group (all P < 0.05). Aldosterone-to-renin ratio was lower in the SAAE group than the MRA group at 1 and 3 months (both P < 0.01), while it had no difference between the two groups at 6 months. None of the patients experienced serious adverse events in the perioperative and 6-month follow-up periods. SAAE, as a hormonal debulking procedure, is superior to MRA in blood pressure control and correction of biochemical abnormalities in patients with idiopathic hyperaldosteronism.

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Funding

This work was partially supported by a grant from National Natural Science Foundation of China (81970262 to P.W.). The funding source had no role in the design of the study and did not participate in study execution, analysis or interpretation of the data, or the decision to submit the results for publication.

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Author notes

  1. These authors contributed equally: Yaqiong Zhou, Xinquan Wang, Jixin Hou

Authors and Affiliations

  1. Department of Cardiology, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, 610500, China

    Yaqiong Zhou, Xinquan Wang, Jixin Hou, Jindong Wan, Yi Yang, Sen Liu, Tao Luo, Qiting Liu & Peijian Wang

  2. Sichuan Clinical Research Center for Geriatrics, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, 610500, China

    Yaqiong Zhou, Xinquan Wang, Jixin Hou, Jindong Wan, Yi Yang, Sen Liu, Tao Luo, Qiting Liu & Peijian Wang

  3. Key Laboratory of Aging and Vascular Homeostasis of Sichuan Higher Education Institutes, Chengdu, Sichuan, 610500, China

    Yaqiong Zhou, Xinquan Wang, Jixin Hou, Jindong Wan, Yi Yang, Sen Liu, Tao Luo, Qiting Liu & Peijian Wang

  4. Yanan hospital affiliated to Kunming medical university, Kunming, Yunnan, 650051, China

    Qiang Xue

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Correspondence to Peijian Wang.

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Zhou, Y., Wang, X., Hou, J. et al. A controlled trial of percutaneous adrenal arterial embolization for hypertension in patients with idiopathic hyperaldosteronism. Hypertens Res 47, 311–321 (2024). https://doi.org/10.1038/s41440-023-01420-w

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