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New Treatment May Offer Quick Cure For Common Cause Of High Blood Pressure
Doctors at Queen Mary University of London, Barts Health NHS Trust, and University College London have led the development of a simple, minimally invasive Targeted Thermal Therapy (Triple T) that has the potential to transform medical management of a common, but commonly overlooked, cause of high blood pressure.
This breakthrough, published today in The Lancet, could, after further testing, help millions of people worldwide who currently go undiagnosed and untreated.
In the UK, Triple T, known scientifically as endoscopic ultrasound-guided radiofrequency ablation, was rigorously tested, in collaboration with researchers 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 affects one in three adults, of whom a hormonal condition called primary aldosteronism accounts for one in twenty cases. However, fewer than one percent of those affected are ever diagnosed.
The condition occurs when tiny benign nodules in one or both adrenal glands produce excess aldosterone, a hormone that raises blood pressure by increasing salt levels in the body. Patients with primary aldosteronism often do not respond well to standard blood pressure medications and face higher risks of heart attacks, strokes, and kidney failure.
A game-changing alternative to surgery
Until now, the only effective cure for primary aldosteronism has been surgical removal of the entire adrenal gland, requiring general anaesthesia, a two-to three-day hospital stay, and weeks of recovery. As a result, many patients go untreated.
Triple T offers a faster, safer alternative to surgery, by selectively destroying the small adrenal nodule without removing the gland. This is made possible by recent advances in diagnostic scans, using molecular dyes that accurately identify and locate even the smallest adrenal nodules. Those in the left adrenal gland are seen to be immediately adjacent to the stomach, from where they can be directly targeted.
The new treatment harnesses the energy of waves, adapting two well-established medical techniques: radiofrequency or microwaves generate heat in a small needle placed into the malfunctioning tissue, causing a controlled burn; ultrasound uses reflected sound waves to create a real-time video of the procedure.
In Triple T, as in routine endoscopy, a tiny internal camera -- in this case using ultrasound as well as light -- is passed by mouth into the stomach. The endoscopist visualises the
adrenal gland and guides a fine needle from the stomach precisely into the nodule. Short bursts of heat destroy the nodule but leave the surrounding healthy tissues unharmed. This minimally invasive approach takes only 20 minutes and eliminates the need for internal or external incisions.
Successful trial shows promise
The study is called FABULAS, the name being an acronym for Feasibility study of radiofrequency endoscopic ABlation, with ULtrasound guidance, as a non-surgical, Adrenal Sparing treatment for aldosterone-producing adenomas.
FABULAS tested Triple T in 28 patients with primary aldosteronism, whose molecular scan had pinpointed a hormone-producing nodule in the left adrenal gland. The new procedure was found to be safe and effective, with most patients having normal hormone levels six months later. Many participants were able to stop all blood pressure medications, with no recurrence of the condition.
Professor Morris Brown, co-senior author of the FABULAS study and Professor of Endocrine Hypertension at Queen Mary University of London, said: "It is 70 years since the discovery in London of the hormone aldosterone, and, a year later, of the first patient in USA with severe hypertension due to an aldosterone-producing tumour. This patient's doctor, Jerome Conn, predicted, with perhaps only minor exaggeration, that 10-20% of all hypertensions might one day be traced to curable nodules in one or both glands. We are now able to realise this prospect, offering 21st-century breakthroughs in diagnosis and treatment."
One of the trial participants, Michelina Alfieri, shared her experience:
"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. I'm incredibly grateful to the team for giving me this choice."
What's next?
The success of FABULAS has led to a larger randomised trial called 'WAVE', which is comparing Triple T with traditional adrenal surgery. The results are expected in 2027.
Professor Stephen Pereira, Chief Investigator of FABULAS and Professor of Hepatology & Gastroenterology at UCL Institute for Liver and Digestive Health, added: "With appropriate training, this less invasive technique could be widely offered 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, said: "This breakthrough was made possible thanks to the collaborative development of novel PET tracer molecules, which enable non-invasive diagnosis by allowing us to precisely locate and treat adrenal nodules for the first time.
"Thanks to this work, we may finally be able to diagnose and treat more people with primary aldosteronism, lowering their risk of developing cardiovascular diseases and other complications, and reducing the number of people dependent on long-term blood pressure medication," he added.
A major step forward for hypertension treatment
For the millions of people suffering from undiagnosed primary aldosteronism, this research offers new hope. Safely targeted thermal therapy, delivered by mouth, could replace major surgery, allowing faster recovery and better outcomes.
With further studies underway, this breakthrough treatment could soon become a standard procedure worldwide, transforming care for patients with this curable form of hypertension.
The research was primarily supported by Barts Charity, National Institute for Health and Care Research (NIHR) through the Barts and Cambridge Biomedical Research Centres (BRCs), and the British Heart Foundation.
It is being followed by a larger randomised trial, called 'WAVE', which will compare TTT to traditional surgery in 120 patients. The results are expected in 2027.
Research Finds A Much More Effective Way To Manage High Blood Pressure
High blood pressure, also known as hypertension, is a common condition that increases the risk of heart disease, strokes, and other serious health problems. Doctors have long advised patients to keep both systolic and diastolic blood pressure within specific ranges.
However, a recent study suggests that the systolic value—the first number in a blood pressure reading—may be far more important than previously thought.
What the Study Found
Researchers from NUI Galway and other institutions analyzed data from over 47,000 patients worldwide. Their goal was to see if lowering diastolic blood pressure (the second number in a reading) too much could be harmful. Surprisingly, they found no evidence that reducing diastolic blood pressure to very low levels caused health problems.
This challenges the traditional belief that diastolic blood pressure needs to stay above a certain threshold for safety. The study suggests that doctors should focus on systolic blood pressure instead when treating patients with hypertension.
What This Means for Treatment
Based on these findings, researchers recommend that treatment should aim to lower systolic blood pressure to between 100-130 mmHg. This means that if systolic blood pressure is under control, doctors no longer need to worry about diastolic blood pressure dropping too low.
This shift in focus could lead to better treatment strategies and may help reduce the risk of heart attacks, strokes, and other complications related to high blood pressure.
How to Prevent High Blood Pressure
While medication is often necessary, lifestyle choices play a key role in preventing and managing high blood pressure. Here are some simple steps to help keep blood pressure in check:
A New Way Forward
This study challenges traditional views on hypertension by showing that systolic blood pressure is the key factor to focus on. By following the new guidelines, doctors can create better treatment plans, leading to safer and more effective management of high blood pressure.
At the same time, preventive measures such as a healthy diet, exercise, and regular check-ups remain crucial for keeping blood pressure under control.
The study was conducted by Bill McEvoy and his team and published in the journal Circulation.
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For more information about high blood pressure, please see recent studies about impact of vitamins on high blood pressure you need to know, and the powerful link between high blood pressure and a potassium-rich diet.
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Treating Hypertension May Help Lower Cognitive Decline Risk
New research confirms that keeping blood pressure in check could help lower cognitive decline risk as we age. Image credit: Oscar Wong/Getty Images.This article originally appeared on Medical News TodayIntensive blood pressure control for adults with hypertension and high cardiovascular risk can reduce the risk of mild cognitive impairment or dementia in the long term, according to a new study.
Current estimates suggest that more than 9 million Americans could have dementia by 2030, and nearly 12 million by 2040. Mild cognitive impairment, a transitional state between normal cognitive aging and dementia, is also expected to increase.
Uncontrolled high blood pressure can result in a greater risk for cognitive decline or dementia as well as cardiovascular disease.
More than half of all Americans experience hypertension by the time they are 50.
Intensive blood pressure control for adults with hypertension (high blood pressure) and high cardiovascular risk can reduce the risk of mild cognitive impairment or dementia in the long term, according to a new study by researchers at Wake Forest University School of Medicine.
This is in the context in which more than 9 million Americans could develop dementia by 2030, and nearly 12 million by 2040. Data also suggest that more than half of all Americans experience hypertension by the time they are 50.
The recent study, published in Neurology, aimed to examine the effects on cognitive decline from standard and intensive blood pressure treatment.
Blood pressure and brain health risksResearchers used data from the landmark Systolic Blood Pressure Intervention Trial, or SPRINT, which compared intensive treatment to standard treatment of systolic blood pressure among people with hypertension, and had results published in 2015.
The findings suggested that lowering systolic blood pressure would reduce the risk of dementia, but the SPRINT study's success in lowering cardiovascular disease meant that it was stopped early, so ultimate results regarding dementia were inconclusive.
The new study's authors aimed to sustain the process of intensive blood pressure treatment for more conclusive results.
SPRINT's researchers incorporated 9,361 patients over the age of 50 in the United States and Puerto Rico, who were randomly assigned to a systolic blood pressure goal of either less than 120 millimeters of mercury (mm Hg), which amounted to an intensive treatment, or less than 140 mm Hg (standard treatment) between 2010 and 2013.
The patients received 3.3 years of treatment and were followed up with until 2018.
The new study's researchers determined the cognitive status of 4,232 (59%) participants (mean age 67 years, 36% female).
During the years of follow-up, 248 of those who had undergone intensive blood pressure treatment were determined to have probable dementia or mild cognitive impairment, compared with 293 participants who had received standard treatment.
The findings confirmed that an intensive treatment of hypertension was associated with a significantly lower risk of mild cognitive decline.
"Over a median of almost 7 years of follow-up, we observed that the previously reported statistically significant reduction in the rate of cognitive impairment (composite of [mild cognitive decline] or probable dementia) was maintained," the researchers write in their study paper.
"The estimated effect on probable dementia, although not statistically significant, was also similar to the primary trial analysis in showing a lower incidence of probable dementia associated with intensive treatment," they further note.
How does blood pressure affect cognition and dementia?American Heart Association data indicate that almost half of adults in the United States have high blood pressure, and most of them are not adequately managing this condition.
Research published in 2022 showed that the longer a person's blood pressure remains under control, the lower their risk for cognitive decline or dementia.
José Morales, MD, a vascular neurologist and neurointerventional surgeon at Providence Saint John's Health Center in Santa Monica, CA, who was not involved in the study, told Medical News Today that, left unchecked, high blood pressure can leave damage beyond cardiovascular impairments:
"Elevated blood pressure leads to end-organ damage in the brain. While it is more commonly associated with stroke, its insidious effects are cognitive impairment. There are likely subclinical changes that are undetectable or unnoticeable due to cognitive reserve, but the degree or extent of brain damage that results in cognitive impairment is most likely many years in the making and insidiously progressing."
What are the best treatments for high blood pressure?The study focused on treatment involving medication rather than any lifestyle changes. Doctors will often recommend a low dose of medication at first, but people with hypertension may need to combine two or more drugs to manage their blood pressure, depending on the person and any underlying medical conditions they may have.
Medications for hypertension include:
"Lifestyle and dietary changes are definitely first line approaches, but when these fail to adequately control hypertension medication becomes necessary," said Morales.
"It really depends patient to patient. Some patients are young and have poorly controlled blood pressure, which is likely causing subclinical damage that increases their later life risk of dementia. In general, the average person with hypertension is middle-aged and studies now implicate this age bracket with significant changes in our body that are a harbinger for future health," he explained.
Cheng-Han Chen, MD, a board-certified interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in Laguna Hills, CA, who also was not involved in the study, told MNT that high blood pressure, if left unchecked, does damage to cognition over years, regardless of age.
However, adults in middle age generally are the most at risk if their blood pressure is beyond normal range.
"There is a not a single age at which high blood pressure permanently leads to cognitive decline. Rather, the negative effects of high blood pressure likely occur over a period of decades," Chen said.
"Some studies point to 'midlife' (age 40's to early 60's) as the period of life during which much of the damage occurs," he noted, which emphasizes the importance of managing blood pressure as we age.
View the original article on Medical News Today
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