Ji Guo, Liu Sen, Wan Jindong, Zhou Yaqiong, Yang Changqiang, Wang Xinquan, He Gaomin, Zeng Anping, Zhang Lingling, Luo Tao, Yang Yi, Wang Dan, Feng Kaige, Hou Jixin, Wang Peijian
Department of Cardiology, School of Clinical Medicine, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan 610500, China.
Key Laboratory of Aging and Vascular Homeostasis at Chengdu Medical College of Sichuan Province, Chengdu, Sichuan 610500, China.
Am J Hypertens. 2025 May 6. doi: 10.1093/ajh/hpaf077.
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.
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.
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.
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.
肾上腺动脉栓塞术（AAE）已被证明在6至12个月的短期随访中可降低特发性醛固酮增多症（IHA）患者的血压（BP）并纠正生化异常。本研究旨在评估单侧AAE在24个月期间的长期疗效和安全性。
这项前瞻性研究纳入了109例行单侧AAE的IHA患者，其中94例完成了24个月的随访。评估包括诊室、家庭及24小时动态血压、生化指标、肾功能和心功能（超声心动图）。记录用药情况和不良事件。
在24个月随访时，诊室、家庭及24小时动态收缩压值分别下降了17.3±23.1、16.4±21.9和9.9±18.6 mmHg（均P<0.001），舒张压值分别下降了8.8±16.1、7.1±15.8和6.4±11.1 mmHg（均P<0.001）。临床完全缓解率和部分缓解率分别为14.9%和50.0%，而生化缓解率分别为13.6%和45.5%。包括血浆醛固酮水平升高、醛固酮-肾素比值（ARRs）增加、血浆肾素受抑制和低钾血症在内的异常生化特征得到显著改善（均P<0.01）。观察到心脏重塑和左心室（LV）舒张功能改善，尤其是左心室质量指数升高者（P<0.05）。未观察到肾功能损害或长期安全性问题的证据。
IHA患者行单侧AAE可在24个月内促进血压持续降低、生化指标纠正、心脏重塑改善和LV舒张功能增强，且无明显长期安全性问题。
