Key result
Superselective adrenal artery embolization reduces office systolic blood pressure by ~20 mmHg in primary aldosteronism.
Why the study?
Superselective adrenal artery embolization has emerged as a minimally invasive alternative to adrenalectomy and MRAs for primary aldosteronism, but its efficacy and safety require systematic evaluation.
Does superselective adrenal artery embolization improve blood pressure and biochemical markers in patients with primary aldosteronism?
Meta-Analysis (n=1,242)
Does superselective adrenal artery embolization improve blood pressure and biochemical markers in patients with primary aldosteronism?
Mean Difference: -19.71
p-value: p=<0.001
Superselective adrenal artery embolization is an effective and safe minimally invasive alternative for managing primary aldosteronism, significantly reducing blood pressure, normalizing biochemical markers, and lowering medication burden.
Background Primary aldosteronism (PA) is a leading cause of secondary hypertension associated with increased cardiovascular and cerebrovascular risk. Superselective adrenal artery embolization (SAAE) has emerged as a minimally invasive alternative to adrenalectomy and mineralocorticoid receptor antagonists (MRAs). This systematic review and meta‐analysis evaluates the efficacy and safety of SAAE in PA management. Methods We searched PubMed, Web of Science, Embase, and Cochrane Library through June 2026 for studies enrolling patients with PA treated by SAAE. Outcomes of interest were changes in blood pressure (BP), biochemical markers (serum potassium, aldosterone, renin activity, and aldosterone‐to‐renin ratio), clinical and biochemical response rates, daily defined dose change, and adverse events. Data were pooled using a random‐effects model. Results Nineteen studies comprising 1242 patients undergoing SAAE met inclusion criteria. SAAE achieved substantial BP reductions: office systolic BP −19.71 mmHg ( p < 0.001), office diastolic BP −10.91 mmHg ( p < 0.001), home systolic BP −18.58 mmHg ( p < 0.001), and 24‐h ambulatory systolic BP −14.57 mmHg ( p < 0.001). Serum potassium increased +0.34 mmol/L ( p < 0.001), aldosterone declined −46.72 ng/dL ( p < 0.001), and ARR decreased −32.64 ( p < 0.001). Complete clinical response occurred in 27% and partial response in 43%; complete biochemical success was achieved in 48% with partial success in 16%. Antihypertensive burden decreased (−0.52 daily defined dose; p < 0.001). Adverse events were predominantly minor (postprocedural pain 37.17%, low‐grade fever 8.55%); serious complications were uncommon (< 1%). Conclusions SAAE is an effective and somewhat safe treatment for PA that achieves meaningful BP control, biochemical normalization, and reduced medication burden. It represents a valuable option for patients ineligible for or intolerant of surgery or MRAs.
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Darmiani et al. (2026) conducted a meta-analysis in Primary aldosteronism (n=1,242). Superselective adrenal artery embolization (SAAE) was evaluated on change in office systolic blood pressure (MD -19.71 mmHg, p=<0.001). Superselective adrenal artery embolization significantly reduced office systolic blood pressure by 19.71 mmHg (p<0.001) and improved biochemical markers in patients with primary aldosteronism.
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