A collaborative team of doctors from Queen Mary University of London, Barts Health NHS Trust, and University College London has developed a revolutionary minimally invasive treatment for primary aldosteronism, offering new hope for millions of patients worldwide. The breakthrough procedure, called Targeted Thermal Therapy (Triple T), has shown promising results in initial trials and could transform the treatment landscape for this underdiagnosed cause of high blood pressure.
Understanding Primary Aldosteronism and Its Impact
Primary aldosteronism affects approximately one in twenty people with high blood pressure, yet fewer than 1% of cases are diagnosed. The condition occurs when benign nodules in the adrenal glands overproduce aldosterone, a hormone that elevates blood pressure by increasing the body's salt levels. Patients with this condition often show poor response to standard antihypertensive medications and face elevated risks of heart attacks, strokes, and kidney failure.
The Triple T Innovation
The new Triple T procedure, scientifically known as endoscopic ultrasound-guided radiofrequency ablation, represents a significant advancement over traditional surgical approaches. The treatment utilizes a combination of radiofrequency or microwave energy to generate heat, delivered through a small needle to precisely target and destroy problematic adrenal nodules while preserving healthy tissue.
The procedure is remarkably efficient, requiring only 20 minutes to complete and involving no external or internal incisions. A tiny camera equipped with ultrasound capability is inserted through the mouth into the stomach, allowing physicians to visualize the adrenal gland and guide the treatment needle with precision.
FABULAS Trial Results
The FABULAS study (Feasibility study of radiofrequency endoscopic ABlation, with ULtrasound guidance, as a non-surgical, Adrenal Sparing treatment for aldosterone-producing adenomas) evaluated Triple T in 28 patients with confirmed left adrenal nodules. The results were compelling:
- Most patients achieved normal hormone levels within six months
- Many participants successfully discontinued all blood pressure medications
- No recurrence of the condition was observed
- The procedure proved both safe and effective
Professor Morris Brown, co-senior author and Professor of Endocrine Hypertension at Queen Mary University of London, highlighted the historical significance: "It is 70 years since the discovery of aldosterone, and we are now able to realize the prospect of treating curable nodules with 21st-century breakthroughs in diagnosis and treatment."
Patient Experience and Real-World Impact
Trial participant Michelina Alfieri shared her success story: "Before the study, I suffered from debilitating headaches for years despite multiple GP visits. As a full-time worker and single parent, my daily life was severely affected. This non-invasive treatment provided an immediate recovery-I was back to my normal routine straight away."
Future Developments and Implementation
The success of the FABULAS trial has paved the way for a larger randomized study called 'WAVE,' which will compare Triple T with traditional adrenal surgery in 120 patients, with results expected in 2027.
Professor Stephen Pereira, FABULAS Chief Investigator, emphasized the potential for widespread adoption: "With appropriate training, this less invasive technique could be widely offered in endoscopy units across the UK and internationally."
The research, supported by Barts Charity, the National Institute for Health and Care Research, and the British Heart Foundation, represents a significant step forward in hypertension treatment. Professor Mark Gurnell of the University of Cambridge noted that this breakthrough could significantly reduce the number of people dependent on long-term blood pressure medication while lowering their risk of cardiovascular complications.
