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Ten-minute scan enables detection and cure of the commonest cause of high blood pressure

Discussion in 'Current Events' started by We Never Know, Jan 24, 2023 at 8:24 PM.

  1. We Never Know

    We Never Know No Slack

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    This could be great news for millions or billions.

    Ten-minute scan enables detection and cure of the commonest cause of high blood pressure

    "Published today in Nature Medicine, the research solves a 60-year problem of how to detect the hormone producing nodules without a difficult catheter study that is available in only a handful of hospitals, and often fails. The research also found that, when combined with a urine test, the scan detects a group of patients who come off all their blood pressure medicines after treatment.

    128 people participated in the study of a new scan after doctors found that their Hypertension (high blood pressure) was caused by a steroid hormone, aldosterone. The scan found that in two thirds of patients with elevated aldosterone secretion, this is coming from a benign nodule in just one of the adrenal glands, which can then be safely removed. The scan uses a very short-acting dose of metomidate, a radioactive dye that sticks only to the aldosterone-producing nodule. The scan was as accurate as the old catheter test, but quick, painless and technically successful in every patient. Until now, the catheter test was unable to predict which patients would be completely cured of hypertension by surgical removal of the gland. By contrast, the combination of a 'hot nodule' on the scan and urine steroid test detected 18 of the 24 patients who achieved a normal blood pressure off all their drugs.

    The research, conducted on patients at Barts Hospital, Cambridge University Hospital, and Guy's and St Thomas's, and Universities of Glasgow and Birmingham, was funded by the National Institute for Health and Care Research (NIHR) and Medical Research Council (MRC) partnership, Barts Charity, and the British Heart Foundation.

    Professor Morris Brown, co-senior author of the study and Professor of Endocrine Hypertension at Queen Mary University of London, said: "These aldosterone-producing nodules are very small and easily overlooked on a regular CT scan. 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."

    Professor William Drake, co-senior author of the study and Professor of Clinical Endocrinology at Queen Mary University of London, said:"This study was the result of years of hard work and collaboration between centres across the UK. 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."

    In most people with Hypertension (high blood pressure), the cause is unknown, and the condition requires life-long treatment by drugs. Previous research by the group at Queen Mary University discovered that in 5-10% of people with Hypertension the cause is a gene mutation in the adrenal glands, which results in excessive amounts of the steroid hormone, aldosterone, being produced. Aldosterone causes salt to be retained in the body, driving up the blood pressure. Patients with excessive aldosterone levels in the blood are resistant to treatment with the commonly used drugs for Hypertension, and at increased risk of heart attacks and strokes."


    Ten-minute scan enables detection and cure of the commonest cause of high blood pressure
     
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  2. Subduction Zone

    Subduction Zone Veteran Member

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    Nice, but it is not quite as helpful as I hoped. If I read it correctly this "most common cause" is still only the cause of 5 to 10% of all blood pressure. Though I may have misunderstood the article.
     
  3. We Never Know

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    The scan found that in two thirds of patients with elevated aldosterone secretion, this is coming from a benign nodule in just one of the adrenal glands, which can then be safely removed.

    "In most people with Hypertension (high blood pressure), the cause is unknown, and the condition requires life-long treatment by drugs. Previous research by the group at Queen Mary University discovered that in 5-10% of people with Hypertension the cause is a gene mutation in the adrenal glands, which results in excessive amounts of the steroid hormone, aldosterone


    Still 5-10% of people which could possibly be cured will be quite a bit if people.
     
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  4. Subduction Zone

    Subduction Zone Veteran Member

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    True. It will be very good news for the 5-10%. But I was hoping for a cure of a much larger number. But still it is an advancement. Very nice article.
     
  5. We Never Know

    We Never Know No Slack

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    Small steps can lead to bigger things
     
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  6. icehorse

    icehorse Veteran Member
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    how about diet, exercise, and stress reduction?
     
  7. Subduction Zone

    Subduction Zone Veteran Member

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    There can be many causes to high blood pressure. This is a medical one. I doubt if that just exercise and diet would work in the case of this sort of high blood pressure.
     
  8. Shadow Wolf

    Shadow Wolf Registered People sTabber

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    Those are usually good starts, but this is dealing with high blood pressure when it's caused by a medical issue and not going to be resolved by more conventional first step means.
    I would imagine in most cases it's already been tried by most research participants, prompting them and their healthcare providers to search for alternatives that lead them to the study.
     
  9. exchemist

    exchemist Veteran Member

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    Here's the research article on which the Queen Mary press release was based:
    [11C]metomidate PET-CT versus adrenal vein sampling for diagnosing surgically curable primary aldosteronism: a prospective, within-patient trial | Nature Medicine

    Indeed this test only diagnoses the cause in 5-10% of people with high blood pressure, and those people will then need surgery to remove the nodule producing the excess aldosterone.

    There is a pair of adrenal glands, sitting on top of the kidneys. From the article, the surgery involved is laparoscopic removal of the gland that contains the nodule, leaving the patient with one gland. This seems to be safe and satisfactory and not too invasive a procedure.

    The radioactive tracer they use is C11, which decays to boron by emission of a positron, with a half-life of 20mins, i.e. effectively gone in a couple of hours, enabling scanning by positron emission tomography (PET).

    One clever bit seems to be that the tracer molecule was a methylated version of a drug called etomidate that is known to inhibit aldocortisone synthesis. This is thus something that is taken up by the adrenal glands. So they chose a tracer specific to the job at hand. It was methylated by bolting a C11-containing methyl group it onto the carboxylate group, thereby converting it to a methyl ester:-


    [​IMG]
     
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