Adrenal artery ablation for primary aldosteronism without apparent aldosteronoma: An efficacy and safety, proof-of-principle trial

Abstract

Primary aldosteronism (PA) is associated with resistant hypertension and cardiovascular events. There are some limitations of current medical and surgical therapies for PA. To determine the efficacy and safety of catheter-based adrenal artery ablation for treatment of PA patients who refused both surgery and medical therapy, we performed this prospective cohort study. Thirty-six PA patients without apparent aldosteronoma were treated by adrenal artery ablation. Primary outcome was postoperative blood pressure and defined daily dose (DDD) of antihypertensive medications after adrenal ablation. Secondary outcome was biochemical success. We assessed outcomes based on Primary Aldosteronism Surgical Outcome (PASO) criteria. Adrenal CT scan, biochemical evaluation, adrenal artery ablation and adrenal venous sampling (AVS) were underwent. After adrenal ablation, complete clinical success (normotension without antihypertensive medication) was achieved in 9/36 (25.0%) patients and partial clinical success (reduction in blood pressure or less antihypertensive medication) in 13/36 (36.1%) patients. Complete biochemical success (correction of hypokalemia and normalization of aldosterone-to-renin ratio) was achieved in 16/36 (44.4%) patients. Office-based and ambulatory blood pressures were reduced by 17/7 and 11/2 mmHg at 6 months after ablation, respectively. The plasma cortisol level in the ablation group decreased slightly, but no patient developed hypoadrenocorticism. Catheter-based adrenal ablation appears to produce substantial and sustained blood pressure reduction and biochemical improvement, with only minor adverse events in PA patients without apparent aldosteronoma. This therapy could be an important supplement for current PA treatments.

Keywords: adrenal artery ablation; antihypertensive therapy; efficacy and safety; primary aldosteronism.

FIGURE 1

Flowchart of the study. Numbers at each follow‐up are those of patients who had attended each predefined visit at the time. Two patients lost to follow‐up at the visit time. Data from patients who had no less than 3 mo follow‐up were enrolled in the final analysis (n = 36)

FIGURE 2

Concordance between CT imaging and AVS laterality. There were 11 patients with normal bilateral adrenals, 13 with unilateral hyperplasia, and 8 with bilateral hyperplasia. In the Figure, data are expressed as n(%). The four APA patients with recurrence PA after surgery were excluded from this analysis. For patients with either no change or bilateral hyperplasia, only AVS can distinguish the ipsilateral or contralateral laterality. APA, aldosterone‐producing adenoma; AVS, adrenal vein sampling; CT, computed tomography