There are 500,000 people in the UK suffering from dangerous hypertension – a “silent killer” that kills tens of thousands of people every year – which can be cured with a new treatment.
Doctors have developed a technique to burn nodules, resulting in large amounts of salt in the body, increasing the risk of stroke or heart attack.
Breakthroughs may mean that people with major aldosteroneism (those who cause 20 high blood pressure) no longer need surgery or peanuts for a lifetime to reduce the risk of stroke or heart attack.
Aldosterone protogenic people form nodules on one or both of their adrenal glands. They sit next to the kidneys and make three key hormones: adrenaline, cortisol and aldosterone. Nodules that develop on one or both glands produce excess aldosterone, a steroid hormone that regulates the amount of salt the body retains, rather than using the kidney to rinse it off. The salt that is retained will then give someone a high blood pressure or high blood pressure.
Primary aldosteronism can make someone’s blood pressure up to 200/130, which is much higher than that of 120/80 doctors say health increases their likelihood of suffering from fatal cardiovascular events. Treatment can be challenging because some patients are not responding well to standard blood pressure medications and are therefore at a high risk of mortality.
Doctors in London and Cambridge have developed this innovative treatment, known as Targeted Thermotherapy (TTT) or endoscopic ultrasound-guided radiofrequency ablation. The medical staff involved said it could “change” the patient’s lives and cure this high blood pressure by using a short burst of needles to destroy the short burst of the nodules.
It takes only 20 minutes, is done under sedation and allows the patient to go home the same day, while the surgery to remove the adrenal glands takes one and a half to two hours, involving the patient undergoing general anesthesia and two to three advanced hospitalizations.
The trial of TTT provided a “proof of principle” in 28 patients with primary aldosterone reported last month in the Lancet. After the surgery, four patients were able to completely detach the medication, while another 12 patients could greatly improve blood pressure or halve it and prevent the body from producing too much aldosterone in three quarters of the participants.
“This process may change the high blood pressure life of 20 people by reducing the risk of stroke, heart attack and arrhythmia. They feel better, have more energy, are less frustrated, and reach normal blood pressure without taking medication or undergoing surgery every day.
Brown, who is also a professor of endocrine hypertension at Queen’s University in London (QMUL), said: “We have known about proprietary aldosteronism for 70 years, but the way we manage it for 30 years hasn’t changed. Now we are able to get rid of the cut-off of the entire organ for the sake of nail-sized nodules and greatly improve the lives of people suffering from hypertension for this particular reason.
“It’s really exciting when uncontrolled hypertension has had this procedure for years and comes home the same day and finds that the next day’s blood pressure returns to normal.”
Experts from QMUL, BARTS, University of London University Hospital NHS Trust, Cambridge University and Addenbrooke Hospital jointly developed the TTT.
A trial further involving 110 patients is testing how TTT works.
Dr Pauline Swift, president of British blood pressure, said the results of the 28-patient trial were “very encouraging. This minimally invasive technique seems to be safe and effective. Potentially many people with high blood pressure may benefit from this new treatment.”
“Hypertension is often called a ‘silence killer’ because it usually has no obvious symptoms but significantly increases the risk of serious health problems such as heart attacks, strokes and kidney disease,” she added.
