Immediate Results and Long-Term Outcomes Following Percutaneous Radiofrequency Ablation of Unilateral Aldosterone-Producing Adenoma

Background: The aim of this study was to evaluate early and long-term clinical and laboratory findings in patients with resistant hypertension secondary to aldosterone-producing adenoma (APA) treated with radiofrequency ablation (RFA). Methods: From July 2009 to September 2017, eight adult patients underwent percutaneous computed tomography (CT)-guided RFA for APA. The safety, efficacy and complications of the procedure were determined. Blood pressure (BP), number of antihypertensive agents, serum potassium, plasma aldosterone and aldosterone-to-renin ratio (ARR) were analyzed before RFA and immediately, short-term and long-term after RFA. Results: The technical success rate was 100%. Two patients developed minor complications but there were no major complications. Clinical improvement was achieved immediately and short-term after RFA. In the long-term (mean follow-up duration of 6.7 +/- 2.1 years) there were significant improvements in systolic (from 162.3 mmHg +/- 18.6 to 125 mmHg 16.1, p = 0.02) and diastolic (from 96.3 mmHg +/- 12.7 to 68.5 mmHg 6.3, p = 0.02) BP, with a significant reduction in the number of antihypertensive agents (from 3.33 +/- 0.82 to 1.33 +/- 1.21, p = 0.02). Hypokalemia improved significantly (serum potassium from 2.16 meq/L +/- 0.22 to 4.34 meq/L +/- 0.54, p = 0.04). Although the plasma aldosterone level decreased significantly, ARR did not (from 100.7 +/- 124.4 to 28.7 +/- 30.7 ng/dL-per-ng/mL/h, p = 0.13). Hypertension was cured in 33.3% of the patients, and the BP of all patients was more easily controlled regardless of the plasma aldosterone and renin status. Conclusions: CT-guided percutaneous RFA appears to be effective and safe to treat patients with APA, with clinical improvements in BP, reduced number of antihypertensive agents, and normalization of serum potassium level. These favorable outcomes persisted in short-term and long-term follow-up.