Doctors at
Queen Mary University of London and Barts Hospital, and Cambridge University
Hospital, have led research using a new type of CT scan to light up tiny
nodules in a hormone gland and cure high blood pressure by their removal. The
nodules are discovered in one-in-twenty people with high blood pressure.
Published today in Nature
Medicine, the research solves a 60-year problem
of how to detect the hormone producing nodules without a difficult catheter
study that is available in only a handful of hospitals, and often fails. The
research also found that, when combined with a urine test, the scan detects a
group of patients who come off all their blood pressure medicines after
treatment.
128 people participated in the study of
a new scan after doctors found that their Hypertension (high blood pressure)
was caused by a steroid hormone, aldosterone. The scan found that in two thirds
of patients with elevated aldosterone secretion, this is coming from a benign
nodule in just one of the adrenal glands, which can then be safely removed. The
scan uses a very short-acting dose of metomidate, a radioactive dye that sticks
only to the aldosterone-producing nodule. The scan was as accurate as the old
catheter test, but quick, painless and technically successful in every patient.
Until now, the catheter test was unable to predict which patients would be
completely cured of hypertension by surgical removal of the gland. By contrast,
the combination of a ‘hot nodule’ on the scan and urine steroid test detected
18 of the 24 patients who achieved a normal blood pressure off all their drugs.
The research, conducted on patients at
Barts Hospital, Cambridge University Hospital, and Guy’s and St Thomas’s, and
Universities of Glasgow and Birmingham, was funded by the National Institute
for Health and Care Research (NIHR) and Medical Research Council (MRC)
partnership, Barts Charity, and the British Heart Foundation.
Professor Morris Brown, co-senior author
of the study and Professor of Endocrine Hypertension at Queen Mary University
of London, said: “These aldosterone-producing nodules are very small and easily
overlooked on a regular CT scan. When they glow for a few minutes after our
injection, they are revealed as the obvious cause of Hypertension, which can
often then be cured. Until now, 99% are never diagnosed because of the
difficulty and unavailability of tests. Hopefully this is about to change.”
Professor William Drake, co-senior
author of the study and Professor of Clinical Endocrinology at Queen Mary
University of London, said:”This study was the result of years of hard work and
collaboration between centres across the UK. Much of the ‘on the ground’ energy
and drive came from the talented research fellows who, in addition to doing
this innovative work, gave selflessly of their time and energy during the
national pandemic emergency. The future of research in this area is in very
safe hands.”
In most people with Hypertension (high blood pressure), the cause is unknown, and the condition requires life-long treatment by drugs. Previous research by the group at Queen Mary University discovered that in 5-10% of people with Hypertension the cause is a gene mutation in the adrenal glands, which results in excessive amounts of the steroid hormone, aldosterone, being produced. Aldosterone causes salt to be retained in the body, driving up the blood pressure. Patients with excessive aldosterone levels in the blood are resistant to treatment with the commonly used drugs for Hypertension, and at increased risk of heart attacks and strokes.
Journal article: https://journals.lww.com/jhypertension/Fulltext/2022/06000/11C_Metomidate_PET_CT_versus_adrenal_vein_sampling.13.aspx
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