Long-term Efficacy and Safety of Unilateral Adrenal Artery Embolization in Patients with Idiopathic Hyperaldosteronism: A 24-month Cohort Study.

BACKGROUND

Adrenal artery embolization (AAE) has been shown to reduce blood pressure (BP) and correct biochemical abnormalities in patients with idiopathic hyperaldosteronism (IHA) during short-term 6-12-month follow-ups. This study aimed to evaluate the long-term efficacy and safety of unilateral AAE over a 24-month period.

METHODS

The prospective study included 109 IHA patients undergoing unilateral AAE, with 94 completing the 24-month follow-up. Evaluations included office, home and 24-hour ambulatory BP, biochemical markers, renal function, and cardiac function (echocardiography). Medication use and adverse events were documented.

RESULTS

At the 24-month follow-up, the office, home, and 24-hour ambulatory systolic BP values decreased by 17.3 ± 23.1, 16.4 ± 21.9, and 9.9 ± 18.6 mmHg, respectively (all P < 0.001), and the diastolic BP values decreased by 8.8 ± 16.1, 7.1 ± 15.8, and 6.4 ± 11.1 mmHg (all P < 0.001). The complete and partial clinical success rates were 14.9% and 50.0%, respectively, whereas those for biochemical success were 13.6% and 45.5%. Abnormal biochemical characteristics, including elevated plasma aldosterone levels, increased aldosterone‒renin ratios (ARRs), plasma renin suppression, and hypokalemia, were significantly improved (all P < 0.01). Improvements in cardiac remodeling and left ventricular (LV) diastolic function were observed, particularly in those with elevated LV mass index (P < 0.05). No evidence of renal impairment or long-term safety concerns was observed.

CONCLUSION

Unilateral AAE in IHA patients promotes sustained BP reduction, biochemical correction, improved cardiac remodeling, and enhanced LV diastolic function over 24 months, with no significant long-term safety concerns.