Hypertension Clinical Trial
Official title:
An Open-label, Cohort Study on Effects and Long-term Prognosis of Adrenal Artery Ablation and Spironolactone in Patients With Primary Aldosteronism
Primary aldosteronism (PA) is one of the most common cause of endocrine and resistant
hypertension. Current studies have shown that the activation of the
renin-angiotensin-aldosterone system (RAAS) and the increased sympathetic nerve activity in
the central or local tissue are the key mechanisms of high blood pressure and its organ
damages.
Current guidelines suggest that surgery and aldosterone receptor inhibitors are the only
treatment for primary aldosteronism. However, only about 35% of aldosterone tumors and a
small number of unilateral adrenal hyperplasia can be treated surgically. More than 60% of
primary aldosteronism and bilateral adrenal hyperplasia need long-term oral aldosterone
receptor inhibitors. At present, spironolactone is the most commonly used aldosterone
receptor inhibitor. Long term use of spironolactone may cause hyperkalemia, hyperplasia of
male mammary gland, hairiness of female and other adverse reactions. Therefore, the
researchers suggest that partial removal of adrenals can reduce aldosterone level, lower
blood pressure and restore potassium metabolism balance.
In patients with primary hyperaldosteronism, the level of aldosterone increases, which can
cause vascular endothelial dysfunction, myocardial injury and ventricular fibrosis. The study
shows that long-term oral administration of spironolactone can reverse the above
cardiovascular damage and correct heart failure. Adrenal artery ablation can reduce
aldosterone level, but the long-term effect on cardiovascular system is unknown. In order to
confirm the effect of adrenal artery ablation on blood pressure and cardiovascular system,
the researchers conducted an open cohort study on patients with primary aldosteronism
(including aldosterone, idiopathic aldosteronism and adrenal hyperplasia). To observe the
effect of adrenal artery ablation and spironolactone on blood pressure, blood electrolyte,
metabolic index, cardiovascular events and cardiovascular death risk in patients with primary
aldosteronism, and to explore its efficacy and safety.
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