Efficacy, Quality of Life, and Cost‐Effectiveness of Superselective Adrenal Arterial Embolization in Idiopathic Hyperaldosteronism: A Comparative Study

Idiopathic hyperaldosteronism (IHA) is the most common subtype of primary aldosteronism, typically managed with mineralocorticoid receptor antagonists (MRAs). However, long‐term MRA therapy is associated with suboptimal cardiovascular outcomes and adverse effects. Superselective adrenal arterial embolization (SAAE) is a novel minimally invasive alternative, but its long‐term efficacy, particularly regarding quality of life and cost‐effectiveness, remains underexplored. In this study, 62 patients with bilateral IHA were prospectively enrolled and assigned to two groups: SAAE ( n = 42) and MRA therapy ( n = 20). Outcomes, including blood pressure, serum potassium, aldosterone‐renin ratio normalization, and quality of life (measured by SF‐36 and EQ‐5D), were assessed at 12 months. A supervised Random Forest model was developed to predict treatment success. A 5‐year cost‐utility analysis compared SAAE and MRA therapy from a healthcare system perspective. Results showed that SAAE led to greater reductions in blood pressure (mean −27.4 ± 21.3 mmHg systolic, −23.1 ± 17.4 mmHg diastolic) compared to MRA therapy (−15.6 ± 11.4 mmHg systolic, −12.4 ± 10.1 mmHg diastolic, p < 0.001). Clinical success was achieved in 63.2% of the SAAE group, with biochemical remission in 39.6%. SAAE also led to greater improvements in quality of life and demonstrated lower costs and higher quality‐adjusted life years (QALYs) compared to MRA therapy. SAAE is a safe, effective, and cost‐effective treatment for IHA, offering superior blood pressure control, hormonal normalization, and improved quality of life compared to MRAs. Trial Registration : ClinicalTrials.gov identifier: ChiCTR2200062738.