New treatment for high blood pressure

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New treatment may offer quick cure for common cause of high blood pressure

Date:
February 10, 2025
Source:
Queen Mary University of London
Summary:
A revolutionary new treatment called Targeted Thermal Therapy (Tripel T) offers a safer, faster alternative to surgery for patients with high blood pressure caused by Primary Aldosteronism, a hormonal disorder.

Development of Triple T for Hypertension Treatment:

  1. Innovation:

    • Doctors at Queen Mary University of London, Barts Health NHS Trust, and UCL developed Triple T (Targeted Thermal Therapy) for treating primary aldosteronism, a common yet overlooked cause of high blood pressure.
    • Minimally invasive, faster, and safer than adrenal gland surgery.

  2. Breakthrough Study:

    • Published in The Lancet.
    • Potential to aid millions worldwide after further testing.

High Blood Pressure & Primary Aldosteronism:

  1. Prevalence:

    • Affects 1 in 3 adults; primary aldosteronism accounts for 1 in 20 cases.
    • Less than 1% diagnosed due to challenges in identifying small adrenal nodules.

  2. Condition Details:

    • Caused by benign adrenal nodules producing excess aldosterone, raising blood pressure.
    • Poor response to standard medications; risks include heart attacks, strokes, and kidney failure.

Triple T: A Surgical Alternative:

  1. Procedure Highlights:

    • Selectively destroys adrenal nodules using endoscopic ultrasound-guided radiofrequency ablation.
    • Requires no external incisions; completed in 20 minutes.
    • Guided by advanced diagnostic scans with molecular dyes.

  2. Mechanism:

    • Combines endoscopy and heat-based techniques (radiofrequency/microwaves).
    • A needle precisely targets nodules via the stomach; healthy tissue remains unharmed.

Successful Clinical Trials:

  1. FABULAS Study:

    • Tested on 28 patients with left adrenal gland nodules.
    • Safe and effective; most achieved normal hormone levels and stopped blood pressure medications.

  2. Patient Experience:

    • Participants reported rapid recovery and symptom relief (e.g., headaches).

Future Steps:

  1. Larger Trials:

    • 'WAVE' trial underway to compare Triple T with traditional adrenal surgery (results by 2027).

  2. Global Potential:

  • Could be widely adopted in endoscopy units.
  • Offers hope to millions with curable hypertension.

Support & Acknowledgments:

  1. Collaborative Effort:
  • Research supported by Barts Charity, NIHR, Cambridge Biomedical Research Centres, and British Heart Foundation.
  • Enabled by novel PET tracers for precise diagnosis.
  1. Impact:

  • Promises to reduce cardiovascular risks and long-term medication dependency.
  • A milestone in hypertension treatment.
Pre-ablation (A) and post-ablation (B) axial PET-CT overlay images for representative patients. (C) Table showing clinical and biochemical outcomes at 6 months for each participant. Partial success is based on PASO definitions, shown in the appendix (p 6). (D) Fine needle biopsy from representative participants obtained endoscopically, immediately before ablation of the adenoma (prior to first ablation only in participant two). Top panels show H and E staining. Adrenocortical cells with either eosinophilic, lipid-poor or lipid-rich cytoplasm are seen in all three participants. Middle panels show immunohistochemistry staining with anti-CYP11B2 while bottom panels show immunohistochemistry staining for anti-CYP11B1 antibodies. Strong uniform staining for CYP11B2 in the lipid-poor cells with reciprocal staining of CYP11B1 in the lipid-rich cells is seen in participants two and four. This confirms the presence of an aldosterone producing adenoma. For participant five, immunohistochemistry shows weak to strong positivity in most cells for CYP11B1. Staining for CYP11B2 is negative, apart from a small group of cells in one of the fragments. It was not possible to confirm a diagnosis of an aldosterone producing adenoma from this fine needle biopsy sample. However, RNA extracted from a second fine needle biopsy sample from the adenoma demonstrated increased CYP11B2 expression on qPCR (appendix p 16). Further details on these three participants can be found in the appendix (p 8) H and E=hematoxylin and eosin. PASO=Primary Aldosteronism Surgical Outcomes. qPCR= quantitative PCR.



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