Radiofrequency ablation for adenoma in patients with primary aldosteronism and hypertension: ADERADHTA, a pilot study

Objective: To evaluate the efficacy and the feasibility of radiofrequency ablation to treat aldosterone-producing adenomas. Methods: In an open prospective bicentric pilot study, patients with hypertension on ambulatory blood pressure measurement, a primary aldosteronism, an adenoma measuring less than 4 cm, and confirmation of lateralization by adrenal venous sampling were recruited. The primary endpoint, based on ABPM performed at 6 months after the radiofrequency ablation, was a daytime SBP/DBP less than 135/85 mmHg without any antihypertensive drugs or a reduction of at least 20 mmHg for SBP or 10 mmHg for DBP. Results: Thirty patients have been included (mean age = 51 ± 11 years; 50% women). Mean baseline daytime SBP and DBP were 144 ± 19 / 95 ± 15 mmHg and 80% received at least two antihypertensive drugs. At 6 months: 47% (95% CI 28–66) of patients reached the primary endpoint, mean daytime SBP and DBP were 131 ± 14 (101–154)/87 ± 10 (71–107) mmHg; 43% of them did not take any antihypertensive drug and 70% of them did not take potassium supplements. Few complications were recorded: four cases of back pain at day 1 postablation; three limited pneumothoraxes, which resolved spontaneously; one lesion of a polar renal artery. Conclusion: Radiofrequency ablation for hypertensive patients with aldosterone-producing adenomas seems to be an emerging promising alternative to surgery. Its efficacy and its feasibility have to be confirmed in a larger sample of patients.