Researchers from Queen Mary University of London, Barts Health NHS Trust, and University College London have pioneered a groundbreaking, minimally invasive treatment referred to as Targeted Thermal Therapy (Triple T) for a prevalent yet frequently unaddressed cause of hypertension. This innovative approach, detailed in The Lancet, could potentially aid millions of people globally who remain undiagnosed and untreated.
The development of Triple T, scientifically known as endoscopic ultrasound-guided radiofrequency ablation, was meticulously tested in collaboration with experts from University College London, University College Hospital NHS Trust, Cambridge University NHS Trust, and the University of Cambridge.
A Hidden Cause of High Blood Pressure
High blood pressure impacts approximately 33% of adults, with primary aldosteronism, a hormonal disorder, accounting for about 5% of such cases. Unfortunately, less than 1% of individuals suffering from this condition receive a diagnosis.
Primary aldosteronism occurs when benign nodules in one or both adrenal glands produce excessive aldosterone, a hormone that raises blood pressure by increasing salt levels in the body. Patients with this condition often do not respond well to traditional blood pressure medications and are at a higher risk of cardiovascular events like heart attacks, strokes, and kidney failure.
A Game-Changing Alternative to Surgery
Traditionally, the only definitive cure for primary aldosteronism has been surgical removal of the entire adrenal gland. This procedure involves general anesthesia, a hospital stay lasting two to three days, and an extended recovery period. As a consequence, many patients opt to forego treatment.
Enter Triple T, which provides a faster, safer alternative to surgery by selectively eliminating the small adrenal nodule while preserving the gland. Advances in diagnostic imaging techniques have enabled the use of molecular dyes to accurately locate and target even the tiniest adrenal nodules. Notably, nodules in the left adrenal gland are situated close to the stomach, making them accessible for direct intervention.
The Triple T method combines the energy from radiofrequency or microwave waves to heat small needles placed directly into the malfunctioning tissue. This controlled heating eliminates the malfunctioning tissue without harming the surrounding healthy cells. Simultaneously, ultrasound technology provides a real-time visual of the procedure, enhancing precision and safety.
Successful Trial Shows Promising Results
The FABULAS study, short for Feasibility study of radiofrequency endoscopic ABlation with ULtrasound guidance, as a non-surgical, Adrenal Sparing treatment for aldosterone-producing adenomas, tested Triple T on 28 patients with primary aldosteronism. The procedure was found to be both safe and effective, with most patients achieving normal hormone levels six months post-treatment. Many of the trial participants were able to discontinue all hypertension medications without any signs of the condition recurring.
Seventy years have passed since aldosterone was discovered in London, and a year later, the first severe hypertension case due to an aldosterone-producing tumor was reported in the USA. Dr. Jerome Conn, the treating physician, envisioned, perhaps with slight exaggeration, that 10 to 20% of all hypertension cases could be attributed to curable nodules in one or both adrenal glands. Today, we are closer to making this vision a reality, offering 21st-century advancements in diagnosis and treatment.
Professor Morris Brown, co-senior author of the FABULAS study and Professor of Endocrine Hypertension at Queen Mary University of London
One of the study participants, Michelina Alfieri, narrates her experience:
“I had debilitating headaches for years, despite multiple visits to my GP. As a full-time worker and single parent, my daily life was greatly impacted. The non-invasive treatment provided quick recovery, and I was able to return to my normal routine immediately. I am immensely thankful to the research team for giving me this option.”
What’s Next?
The success of the FABULAS trial has initiated a larger randomized trial, named ‘WAVE’, to compare Triple T with traditional adrenal surgery. The results are anticipated in 2027.
Professor Stephen Pereira, the principal investigator of FABULAS and Professor of Hepatology & Gastroenterology at UCL Institute for Liver and Digestive Health, commented, “With suitable training, this less invasive technique could be widely available in endoscopy units across the UK and internationally.”
Clinical Endocrinology Lead at Addenbrooke’s Hospital and Professor of Clinical Endocrinology at the University of Cambridge, Professor Mark Gurnell, emphasized, “This breakthrough is possible due to the collaborative creation of novel PET tracer molecules that allow us to non-invasively diagnose and treat adrenal nodules for the first time.”
He added, “Thanks to this research, we may finally diagnose and treat more people suffering from primary aldosteronism, lowering their risk of cardiovascular diseases and complications, and reducing their dependence on long-term blood pressure medications.”
A Significant Step Forward in Hypertension Treatment
The discovery of Triple T offers new hope to the millions living with undiagnosed primary aldosteronism. This non-surgical, minimally invasive method could replace major surgery, allowing for quicker recovery and better outcomes.
With ongoing studies, this novel treatment is expected to become a standard procedure, revolutionizing how we manage this curable form of hypertension.
The research was primarily supported by Barts Charity, National Institute for Health and Care Research (NIHR) via the Barts and Cambridge Biomedical Research Centres (BRCs), and the British Heart Foundation.
A follow-up randomized trial, ‘WAVE’, will compare Triple T with traditional surgery in 120 participants. Results are anticipated in 2027.
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