A new study published today shows a ten-minute scan that can successfully detect and treat the commonest cause of high blood pressure.

Hypertension, or high blood pressure, affects a majority of people, with the cause being unknown in most cases. As a result, lifelong drug treatment is necessary.

A recent study by researchers at Queen Mary University found that a genetic mutation in the adrenal glands is the cause of hypertension in 5-10% of cases.

The mutation leads to the overproduction of the steroid hormone aldosterone, which causes the retention of salt and raises blood pressure.

Individuals with high levels of aldosterone in their blood are unresponsive to typical hypertension medications and have a heightened risk of heart attacks and strokes.

A team of doctors from Queen Mary University of London, Barts Hospital, and Cambridge University Hospital have developed a new CT scan technique that detects and cures high blood pressure by removing small nodules in a hormone gland. These nodules are present in one in twenty individuals with high blood pressure. The research, published in Nature Medicine, solves a long-standing issue of how to identify these hormone-producing nodules without the need for a complicated catheter study, which is only available at a limited number of hospitals and often yields inaccurate results.

In addition to its diagnostic capabilities, the study also revealed that the scan, in combination with a urine test, is able to identify a group of patients who no longer require any blood pressure medication following treatment. A total of 128 individuals with hypertension caused by the steroid hormone aldosterone participated in the study of this new scan.

The scan revealed that in two thirds of patients with high levels of aldosterone secretion, the cause is a benign nodule in a single adrenal gland that can be safely removed. This new scan utilizes a small dose of metomidate, a radioactive dye that specifically targets the aldosterone-producing nodules, making it as accurate as the previous catheter test but quicker, more comfortable and technically successful in every patient.

Previously, the catheter test was unable to determine which patients would have their hypertension cured through the surgical removal of the gland. However, the combination of the “hot nodule” on the scan and urine steroid test was able to identify 18 out of 24 patients who were able to achieve normal blood pressure without medication.

“These aldosterone-producing nodules are very small and easily overlooked on a regular CT scan,” explains senior co-author professor Morris Brown.

“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.”

“This study was the result of years of hard work and collaboration between centres across the UK,” remarks senior co-author professor William Drake.

“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.”

Source: 10.1038/s41591-022-02114-5

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