Doctors at Queen Mary University of London, Barts Health NHS Trust, and University College London have led the development of Targeted Thermal Therapy (Triple T), a simple, minimally invasive procedure that has the potential to revolutionise medical management of a common but often overlooked cause of high blood pressure.
England [UK], February 10 (ANI): Doctors
at Queen Mary University of London, Barts Health NHS Trust, and University
College London have led the development of Targeted Thermal Therapy (Triple T),
a simple, minimally invasive procedure that has the potential to revolutionise
medical management of a common but often overlooked cause of high blood
pressure.
This breakthrough could with additional testing, benefit millions of people worldwide who are currently 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.
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
per cent 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.
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.
The study
is called FABULAS, the name being an acronym for a 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 hypertension 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."
"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."
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.
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. (ANI)
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