New treatment could cure high blood pressure due to primary aldosteronism

Half a million people in the UK with dangerously high blood pressure – a “silent killer” that causes tens of thousands of deaths a year – could be cured by a new treatment.

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.

“This procedure could potentially transform life for one in 20 people with high blood pressure by reducing their risk of stroke, heart attack and heart arrhythmias. They feel better, they have more energy, they are less depressed and they achieve a normal blood pressure without having to take a medication every day or having surgery,” said Prof Morris Brown, a co-author of the Lancet study and professor of endocrinology at Barts Health NHS trust in London.

Brown, who is also a professor of endocrine hypertension at Queen Mary University of London (QMUL), said: “We have known about primary aldosteronism for 70 years but nothing has changed in how we manage it for 30 years. And now we are able to get away from cutting out an entire organ for the sake of a fingernail-sized nodule and hugely improve the lives of people who have high blood pressure for this particular reason.

“It’s very exciting when people who’ve had uncontrolled high blood pressure for years have this procedure and come home the same day and find that their blood pressure is back to normal literally the next day.”

Experts from QMUL, Barts, University College London Hospitals NHS trust, Cambridge University and Addenbrooke’s hospital in Cambridge jointly developed TTT.

A further trial, involving 110 patients, is under way to test how TTT works.

Dr Pauline Swift, the chair of Blood Pressure UK, said the results of the 28-patient trial “are very encouraging. This minimally invasive technique appears to be safe and effective. There are potentially many individuals living with high blood pressure that may benefit from this new treatment.”

She added: “High blood pressure is often called the ‘silent killer’ because it usually presents no noticeable symptoms yet significantly increases the risk of serious health issues such as heart attacks, strokes and kidney disease.”