Clinical trial NCT03398785: Adrenal Artery Ablation Treats Primary Aldosteronism
Official title: An Open-label, Prospective, Controlled Clinical Trial on Effects and Safety of Adrenal Artery Ablation (Triple A) for Primary Aldosteronism
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE3
Conditions: Primary Aldosteronism
Hypertension
Keywords: Primary Aldosteronism
Hypertension
Ablation
Adrenal Gland
Lead sponsor: Third Military Medical University
Sponsor class: OTHER
First posted: 2018-01-12
Enrollment: 66
Sex: ALL
Minimum age (years): 30
Maximum age (years): 60
Standard ages: ADULT
Accepts healthy volunteers: no
Allocation: NON_RANDOMIZED
Intervention model: PARALLEL
Intervention model description: Patients in the Intervention group will be treated with endovascular chemical ablation of adrenal gland by endovascular injection of dehydrated alcohol. Patients in the Control group will be treated with conventional anti-hypertensive drugs
Primary purpose: TREATMENT

Brief summary: Primary aldosteronism (PA) is one of the most common cause of endocrine and resistant hypertension. Current studies have shown that the activation of the renin-angiotensin-aldosterone system (RAAS) and the increased sympathetic nerve activity in the central or local tissue are the key mechanisms of high blood pressure and its organ damages.

The classical method for diagnosis of primary aldosteronism depends on the detection of peripheral venous blood aldosterone level, which is incapable of accurate positioning diagnosis. On the other hand, the current guidelines recommend that surgery and aldosterone receptor inhibitors were the only treatment for primary aldosteronism. However, only about 35% of aldosterone tumors and a small part of unilateral adrenal hyperplasia can be treated by surgery. More than 60% of idiopathic aldosteronism and bilateral adrenal hyperplasia need long-term drug therapy. However, long-term aldosterone inhibitor treatment may also cause hyperkalemia, male breast hyperplasia, female hirsutism and other adverse reactions.

Therefore, the investigators proposed that endovascular chemical partial ablation of the adrenal gland can lower the aldosterone level, reduce the blood pressure and recover the potassium metabolism balance. In order to confirm the above effects, the investigators conduct an open, prospective, positive controlled study in patients with primary aldosteronism patients (including aldosterone, idiopathic aldosteronism and adrenal hyperplasia). The effects on blood pressure, blood electrolytes, adrenal hormones, metabolic indexes, target organ damages were observed to explore the efficacy and safety of the endovascular ablation of the adrenal gland in the treatment of primary aldosteronism.


Eligibility criteria: Inclusion Criteria:

* Primary Aldosteronis diagnosed by increased Renin ratio (ARR) and serum aldosterone levels ≥15 ng / dl, and confirmed by saline injection test or captopril inhibition test.
* Idiopathic aldosteronism, bilateral adrenal hyperplasia, and unilateral adrenal hyperplasia with no superior secretion confirmed with adrenal CT and adrenal venous blood (AVS).
* The patients was diagnosed with aldosteronoma or unilateral adrenal hyperplasia but refused to surgical excision.
* Signed informed consent and agreed to participate in this study.

Exclusion Criteria:

* Aldosterone cancer.
* Hyperkalemia.
* Renal failure or the following history of nephropathy: serum creatinine 1.5 times higher than the upper limit; dialysis history; or nephrotic syndrome.
* Secondary hypertension except the primary aldosteronism.
* Adrenergic insufficiency.
* Heart failure with NYHA grade Ⅱ-Ⅳ grade or unstable angina, severe cardiovascular and cerebrovascular stenosis, myocardial infarction, intracranial aneurysm, stroke and other acute cardiovascular events.
* Acute infections, tumors and severe arrhythmias, psychiatric disorders, drugs or alcohol addicts.
* Liver dysfunction or the following history of liver disease: AST or ALT 2 times higher than the upper limit, liver cirrhosis, history of hepatic encephalopathy, esophageal variceal history or portal shunt history.
* Coagulation dysfunction.
* Pregnant women or lactating women.
* Participated in other clinical trials or admitted with other research drugs within 3 months prior to the trial.
* Any surgical or medical condition which can significantly alter the absorption, distribution, metabolism, or excretion of any study drug.
* Allergy or any contraindications for the study drugs, contrast agents and alcohol.
* Refused to sign informed consent

Primary outcomes:
measure: Change of 24-h average systolic blood pressure compared with the baseline
timeFrame: 24 weeks
Secondary outcomes:
measure: Change of 24-h average systolic blood pressure between two groups
timeFrame: 24 weeks
measure: Change of anti-hypertensive regimen between two groups
timeFrame: 24 weeks
measure: Change of 24-h average diastolic blood pressure, daytime mean systolic blood pressure, daytime mean diastolic blood pressure, and nighttime average systolic and diastolic blood pressure between two groups
timeFrame: 24 weeks
measure: Change of office systolic and diastolic pressure between two groups
timeFrame: 24 weeks
measure: Change of blood electrolytes（serum potassium and natrium in mmol/L）
timeFrame: 24 weeks
measure: Change of plasma aldosterone and 24-h urine aldosterone
timeFrame: 24 weeks
measure: Change of plasma renin
timeFrame: 24 weeks
measure: Change of plasma cortisol and 24-h urine cortisol
timeFrame: 24 weeks
measure: Change of liver enzymes (ALT, AST)
timeFrame: 24 weeks
measure: Change of serum creatinine
timeFrame: 24 weeks
measure: Change of fasting blood glucose
timeFrame: 24 weeks
measure: Change of lipids profiles (TC, HDL-C, LDL-C, TG) in mmol/L
timeFrame: 24 weeks
Other outcomes:
measure: Change of testosterone and estrogen levels
timeFrame: 24 weeks
measure: Change of 24-h urine microalbumin, microalbumin/creatinine ratio
timeFrame: 24 weeks
measure: Change of parameters assessed by echocardiography (IVSd、IVSs、LVPWd, LVPWs, LVEDD, LVEF, LVM)
timeFrame: 24 weeks
measure: Change of carotid intima-media thickness assessed by carotid ultrasound
timeFrame: 24 weeks
measure: Change of electrocardiogram manifestations
timeFrame: 24 weeks
Locations:
city: Chongqing
country: China
facility: The third hospital affiliated to the Third Military Medical University
state: Chongqing
Study officials:
References:
citation: Sun F, Hong Y, Zhang H, Liu X, Zhao Z, He H, Yan Z, Zhu Z. Determination of adrenal hypersecretion in primary Aldosteronism without aldosterone-production adenomas. BMC Endocr Disord. 2021 May 31;21(1):114. doi: 10.1186/s12902-021-00770-1.