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Rationality and implication of catheter-based adrenal ablation for bilateral primary aldosteronism

Hypertension Research volume 47, pages 2884–2894 (2024)Cite this article

Abstract

Mineralocorticoid receptor antagonists (MRAs) for bilateral primary aldosteronism (PA) are the mainstay option recommended by guidelines, but poor compliance occurs due to numerous side effects. We aimed to examine whether catheter-based adrenal ablation could be an alternative treatment for bilateral PA.644 PA patients were included from a total of 6054 hypertensive patients. Adrenal CT scan and adrenal venous sampling (AVS) were both performed for PA subtype classification. Clinical and biochemical outcomes were assessed at 6 months after treatment according to the Primary Aldosteronism Surgical Outcome (PASO) criteria.93 patients with PA were recruited to be treated by adrenal ablation, including 25 bilateral PA and 68 unilateral PA according to AVS results. Office SBP and DBP significantly decreased from baseline levels, serum potassium levels increased and ARR significantly decreased (p < 0.01) in both the bilateral and unilateral groups. In the bilateral group, complete, partial and absent clinical success was achieved in 6 (24.0%), 11 (44.0%) and 8(32.0%) patients, respectively. In the unilateral group, complete, partial and absent clinical success was achieved in 12 (17.6%), 37 (54.4%), and 19 (27.9%) patients, respectively. The numbers of patients achieving complete, partial, and absent biochemical success were 15 (60.0%), 6 (24.0%), and 4 (16.0%), respectively, in the bilateral group versus 37 (54.4%), 9 (13.2%), and 22 (32.3%), respectively, in the unilateral group. In conclusion, we provide evidence for the beneficial outcomes of unilateral adrenal ablation for patients with bilateral PA. Our findings provide insight into an alternative option for patients with bilateral excess aldosterone.

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Acknowledgements

We acknowledge the Chongqing Endocrine Hypertension Collaborative Team for their contributions to this trial.

Chongqing Endocrine Hypertension Collaborative Team:

Hongyun Miao2, Zhiyong Li3, Ping Wei4, Min Long5, Xiaoli Chen6, Peijin Xia7, Xiaoyun Fan8, Wuquan Deng9, Yangjie He10, Qingbin Liao11, Xingrong Tan12, Liping Zhang13, Yong Luo14, Yong Liao15

Funding

This project has received funding from the National Natural Science Foundation of China (81920108010, 81900380, 81721001, U21A20354) and Third Military Medical University for funding of the Triple A program led by ZMZ.

Author information

Authors and Affiliations

  1. Department of Hypertension and Endocrinology, Daping Hospital, Army Medical, University of PLA, Center for Hypertension and Metabolic Diseases, ChongqingInstitute of Hypertension, Chongqing, 400042, China

    Fang Sun, Hexuan Zhang, Hongbo He, Qiang Li, Zhigang Zhao, Nan Jiang, Xiaona Bu, Xiaoli Liu, Zhencheng Yan & Zhiming Zhu

  2. Jiangjin District Center Hospital, Chongqing, China

    Hongyun Miao

  3. Yongchuan Hospital of Chongqing Medical University, Chongqing, China

    Zhiyong Li

  4. Southwest Hospital, Chongqing, China

    Ping Wei

  5. Xinqiao Hospital, Chongqing, China

    Min Long

  6. Yubei District People’s Hospital of Chongqing, Chongqing, China

    Xiaoli Chen

  7. Fuling Central Hospital of Chongqing, Chongqing, China

    Peijin Xia

  8. The Sixth People’s Hospital of Chongqing, Chongqing, China

    Xiaoyun Fan

  9. Chongqing Emergency Medical Center, Chongqing, China

    Wuquan Deng

  10. Dazu District People’s Hospital of Chongqing, Chongqing, China

    Yangjie He

  11. Dadukou District People’s Hospital of Chongqing, Chongqing, China

    Qingbin Liao

  12. The Ninth People’s Hospital of Chongqing, Chongqing, China

    Xingrong Tan

  13. Fengdu County People’s Hospital of Chongqing, Chongqing, China

    Liping Zhang

  14. Chongqing Three Gorges Central Hospital, Chongqing, China

    Yong Luo

  15. Chongqing Corps Hospital of Armed Police Force, Chongqing, China

    Yong Liao

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  1. Fang Sun
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  2. Hexuan Zhang
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  3. Hongbo He
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  8. Xiaoli Liu
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  9. Zhencheng Yan
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  10. Zhiming Zhu
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Consortia

Chongqing Endocrine Hypertension Collaborative Team

  • Hongyun Miao
  • , Zhiyong Li
  • , Ping Wei
  • , Min Long
  • , Xiaoli Chen
  • , Peijin Xia
  • , Xiaoyun Fan
  • , Wuquan Deng
  • , Yangjie He
  • , Qingbin Liao
  • , Xingrong Tan
  • , Liping Zhang
  • , Yong Luo
  •  & Yong Liao

Corresponding author

Correspondence to Zhiming Zhu.

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Sun, F., Zhang, H., He, H. et al. Rationality and implication of catheter-based adrenal ablation for bilateral primary aldosteronism. Hypertens Res 47, 2884–2894 (2024). https://doi.org/10.1038/s41440-024-01815-3

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