Doctors have developed a technique to burn away nodules that lead to a large amount of
salt building up in the body, which increases the risk of a stroke or heart attack.
The breakthrough could mean people with
primary aldosteronism – which causes one in 20 cases of high blood pressure – no longer have to have surgery or spend their lives taking the drug
spironolactone to lower their risk of a stroke or heart attack.
People with primary aldosteronism develop nodules on one or both of their adrenal glands. They sit beside the kidneys and make three key hormones: adrenaline, cortisol and aldosterone. Nodules, which can develop on one or both glands, produce excess amounts of aldosterone, a steroid hormone which regulates how much salt the body retains instead of using the kidneys to flush it away. The retained salt then gives someone high blood pressure or hypertension.
Primary aldosteronism can send someone’s blood pressure as high as 200/130, far above the 120/80 level doctors say is healthy, increasing the probability they may suffer a fatal cardiovascular event. It can be challenging to treat because some patients do not respond well to standard blood pressure medications and thus remain at heightened risk of death.
Doctors in London and Cambridge have developed the innovative treatment, which is called targeted thermal therapy (TTT) or endoscopic ultrasound-guided radiofrequency ablation. It could “transform” the lives of patients and cure that type of high blood pressure by using short bursts of intense heat from a needle to destroy the nodules, medics involved say.
It takes only 20 minutes, is done under sedation and allows the patient to go home that day, whereas surgery to remove an adrenal gland takes one and a half to two hours and involves the patient having a general anaesthetic and a two or three-night stay in hospital.
A trial of TTT in 28 patients with primary aldosteronism reported in The Lancet last month provided “proof of principle”. Four patients were able to come off drugs altogether after undergoing the procedure while another 12 greatly improved their blood pressure or halved their drug intake, and it stopped the body producing too much aldosterone in three-quarters of participants.
