Key result
Radiofrequency ablation for aldosterone-producing adenomas achieves target BP in ~47% of patients at 6 months.
Why the study?
The efficacy and feasibility of radiofrequency ablation to treat aldosterone-producing adenomas in hypertensive patients were not established.
Does radiofrequency ablation improve blood pressure control in patients with primary aldosteronism and hypertension?
Does radiofrequency ablation improve blood pressure control in patients with primary aldosteronism and hypertension?
Radiofrequency ablation of aldosterone-producing adenomas is feasible and achieved the primary blood pressure endpoint in 47% of patients at 6 months, suggesting it may be a promising alternative to surgery.
Supports further investigation of ablation for aldosterone-producing adenomas; leaves open comparative efficacy versus medical therapy.
OBJECTIVE: To evaluate the efficacy and the feasibility of radiofrequency ablation to treat aldosterone-producing adenomas. METHODS: In an open prospective bicentric pilot study, patients with hypertension on ambulatory blood pressure measurement, a primary aldosteronism, an adenoma measuring less than 4 cm, and confirmation of lateralization by adrenal venous sampling were recruited. The primary endpoint, based on ABPM performed at 6 months after the radiofrequency ablation, was a daytime SBP/DBP less than 135/85 mmHg without any antihypertensive drugs or a reduction of at least 20 mmHg for SBP or 10 mmHg for DBP. RESULTS: Thirty patients have been included (mean age = 51 ± 11 years; 50% women). Mean baseline daytime SBP and DBP were 144 ± 19 / 95 ± 15 mmHg and 80% received at least two antihypertensive drugs. At 6 months: 47% (95% CI 28-66) of patients reached the primary endpoint, mean daytime SBP and DBP were 131 ± 14 (101-154)/87 ± 10 (71-107) mmHg; 43% of them did not take any antihypertensive drug and 70% of them did not take potassium supplements. Few complications were recorded: four cases of back pain at day 1 postablation; three limited pneumothoraxes, which resolved spontaneously; one lesion of a polar renal artery. CONCLUSION: Radiofrequency ablation for hypertensive patients with aldosterone-producing adenomas seems to be an emerging promising alternative to surgery. Its efficacy and its feasibility have to be confirmed in a larger sample of patients.
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Bouhanick et al. (2020) studied Primary aldosteronism and hypertension (n=30). Radiofrequency ablation was evaluated on Daytime SBP/DBP less than 135/85 mmHg without any antihypertensive drugs or a reduction of at least 20 mmHg for SBP or 10 mmHg for DBP (95% CI 28-66). Radiofrequency ablation for aldosterone-producing adenomas achieved the primary blood pressure reduction endpoint in 47% (95% CI 28-66) of patients at 6 months.
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