Entering China
Recently, the team of the Department of Cardiology of Jiangsu Provincial Hospital of Traditional Chinese Medicine and the Clinical Innovation Center of Jiangsu Provincial Clinical Innovation Center for Traditional Chinese Medicine Hypertension carried out adrenal venous sampling (AVS) with superb skills, and successfully carried out accurate diagnosis and treatment for many patients with secondary hypertension. The breakthrough application of this technology marks a new level in the diagnosis and treatment of secondary hypertension and adrenal gland diseases, bringing new hope for the cure of patients suffering from hypertension for a long time.
After more than ten years, the “stubborn disease” was finally solved
Precise diagnosis and treatment have shown results
Mr. Li, 55, has been suffering from high blood pressure for more than 10 years, and has been taking a variety of antihypertensive drugs for a long time but with little effect, with blood pressure reaching as high as 190/110mmHg, and repeated symptoms such as dizziness and fatigue. The Department of Cardiovascular Medicine of Jiangsu Provincial Hospital of Traditional Chinese Medicine found that Mr. Li not only had severe hypokalemia (serum potassium 2.74mmol/L), but also showed that the right adrenal gland hyperplasia nodule (1.35cm in size) was also detected by adrenal CT with contrast, and it was highly suspected that he was suffering from primary aldosteronism (protoaldehyde), a common cause of secondary hypertension with hypertension and hypokalemia as typical symptoms.
Unilateral or bilateral adrenal cortex lesions oversecrete a hormone called aldosterone, which disrupts the balance of water and electrolytes (mainly sodium and potassium) in the body, resulting in sodium and water retention. The typical clinical symptom is elevated blood pressure, and some patients have hypokalemia. Studies have found that excessive aldosterone is an important risk factor for myocardial hypertrophy, heart failure and renal damage, and compared with patients with essential hypertension, patients with protoaldehyde disease have more serious damage to hypertensive target organs such as heart and kidney, so early diagnosis and early treatment are crucial.
In response to this clinical problem, the team led by Jiang Weimin and Liu Ming of the Department of Cardiovascular Medicine formulated an accurate diagnosis plan for it – the implementation of AVS technology. By measuring the levels of aldosterone and cortisol in both adrenal veins, the patient’s right adrenal hyperplasia nodule was determined to determine whether the patient’s right adrenal hyperplasia nodule had the function of secreting aldosterone (i.e., the “dominant side” considered to be of clinical significance), so as to accurately determine whether the patient’s adrenal gland had a dominant secretory side, which provided a guarantee for precise treatment and accurate positioning of subsequent surgery. After sufficient preoperative assessment and communication, the interventional team successfully completed precise blood collection in the patient’s bilateral adrenal veins, inferior vena cava and periphery with skillful technology. In this patient, there was no significant difference in the levels of aldosterone secreted by the adrenal glands between the two sides. This result suggests that Mr. Li’s excess aldosterone does not come from the right adrenal gland alone, and surgical removal of the right adrenal gland does not solve the problem. In the end, the expert team determined a treatment plan for Mr. Li to take the medicine for a long time. After adjustment, Mr. Li’s blood pressure is stable and he has recovered and been discharged from the hospital.
AVS Technology: The “Gold Standard” for Diagnosis of Orthoaldehyde Classification
The data showed that the prevalence of orthoaldehyde disease in patients with grade 1-3 hypertension was 1.99%, 8.02% and 13.2%, respectively, and compared with patients with essential hypertension, the damage to the heart and kidneys and other hypertensive target organs in patients with orthoaldehyde disease was more serious. Adrenal vein sampling (AVS) is currently recognized as the “gold standard” for the diagnosis of orthoaldehyde, and distinguishing between predominant secretion and predominance in orthoaldehyde is crucial to the selection of treatment regimens. This technique uses a minimally invasive interventional method to insert catheters into bilateral adrenal central veins to collect blood in segments, which can directly and accurately measure the levels of adrenal local hormones such as aldosterone and cortisol. However, due to the small opening of the right adrenal vein and the large anatomical variation, the intervention technology of the operator is extremely high, and this technology is only carried out in a few hospitals in China.
Experts say that hypertension is the leading cause of cardiovascular disease and death worldwide, and primary hyperaldosteronism is one of the most common causes of secondary hypertension. The successful development of AVS technology in Jiangsu Provincial Hospital of Traditional Chinese Medicine not only provides important technical support for guiding the “classification” diagnosis and subsequent precision treatment of patients with primary aldehyde, but also promotes the overall improvement of the accurate diagnosis and treatment of secondary hypertension in the hospital.
Popular science tips
Who should be alert to protoaldehyde?
1. Refractory hypertension: those who cannot control blood pressure (>140/90mmHg) despite the combination of 3 conventional antihypertensive drugs (including diuretics), or who need more than 4 drugs to reach the target;
2. Hypertension with hypokalemia: patients with hypertension combined with spontaneous hypokalemia or hypokalemia caused by diuretics;
3. Patients with hypertension and adrenal abnormalities: adrenal hyperplasia, nodules or adenoma found by imaging examination;
4. Patients with a high-risk family history of hypertension: family history of early-onset hypertension (< 40 years old) or family history of cerebrovascular accident;
5. Have a family history of protoaldehyde: first-degree relatives of patients with protoaldehyde;
6. Patients with hypertension and obstructive sleep apnea.
