Triple T shows promise in curing high blood pressure

A revolutionary new treatment called Targeted Thermal Therapy (Triple T) has shown promise as a safer, faster alternative to surgery for patients suffering from high blood pressure caused by Primary Aldosteronism.

The procedure published in The Lancet, was developed by experts at Queen Mary University, London in collaboration with several other institutions, offering hope to millions of people worldwide who are currently undiagnosed and untreated for this common yet often overlooked cause of high blood pressure.

The new treatment, scientifically known as endoscopic ultrasound-guided radiofrequency ablation, was rigorously tested in a study called FABULAS. The study’s name is an acronym for Feasibility study of radiofrequency endoscopic Ablation, with Ultrasound guidance, designed as a non-surgical, adrenal-sparing treatment for aldosterone-producing adenomas.

FABULAS report tested Triple T in 28 patients with primary aldosteronism, whose molecular scan had pinpointed a hormone-producing nodule in the left adrenal gland and the study found the new procedure to be safe and effective, with most patients having normal hormone levels six months later while many participants were able to stop all blood pressure medications, with no reported recurrence of the condition.

High blood pressure also known as Hypertension is a medical condition having consistently elevated blood pressure levels due to the force of blood pushing against the walls of your arteries and as such, significantly increases the risk of heart, brain, kidney and other diseases.

According to the World Health Organisation (WHO), almost one in three adults is hypertensive, with male prevalence slightly higher than females globally and also known as one of the major causes leading to heart attacks, heart failure, and stroke, collectively known as cardiovascular diseases (CVD), and chronic kidney damage.

The researchers explained that a hormonal condition called primary aldosteronism accounts for one in 20 cases of high blood pressure, however, less than one per cent of those affected are ever diagnosed.

The team explained that the condition is caused by benign nodules in one or both adrenal glands, which produce excess aldosterone, a hormone that raises blood pressure by increasing sodium levels in the body.

Standard blood pressure medications typically do not work for patients with primary aldosteronism, and these patients are at higher risk of severe complications, including heart attacks, strokes, and kidney failure.

Before now, the only effective treatment for primary aldosteronism was the surgical removal of the affected adrenal gland. This procedure required general anaesthesia, a hospital stay of two to three days, and a lengthy recovery period.

As a result, many patients with primary aldosteronism went untreated. However, Triple T offers a non-invasive solution that selectively destroys the small nodule in the adrenal gland without removing the entire gland, offering a safer and quicker alternative to traditional surgery.

The new treatment, according to the experts works by using two well-established medical techniques: radiofrequency (or microwaves) and ultrasound. Radiofrequency waves generate heat that is delivered through a fine needle inserted directly into the malfunctioning tissue of the adrenal gland, causing a controlled burn.

Meanwhile, ultrasound provides real-time images of the procedure, allowing the medical team to target the nodule precisely without harming surrounding tissues.

Chief Investigator of FABULAS, Prof Stephen Pereira, emphasised the significance of the findings as the treatment takes only 20 minutes to perform, eliminating the need for invasive surgery, reducing recovery times and eliminating the risks associated with general anaesthesia.

“With appropriate training, this less invasive technique could be widely offered in endoscopy units across the UK and internationally,” she said. One of the trial participants, Michelina Alfieri, shared her experience with the new treatment. Before joining the study, Alfieri had suffered from debilitating headaches for years, despite multiple visits to her general practitioner.

Her condition, she explained, severely impacted her daily life, especially as a full-time worker and single parent. “This non-invasive treatment provided an immediate recovery. I was back to my normal routine straight away,” Alfieri said.

A clinical endocrinologist at the University of Cambridge, Mark Gurnell, explained that the significance of this breakthrough lies not only in its effectiveness but in its potential to lower the long-term dependence on blood pressure medications.

He said, “Thanks to this work, we may finally be able to diagnose and treat more people with primary aldosteronism, lowering their risk of developing cardiovascular diseases and other complications, and reducing the number of people dependent on long-term blood pressure medication.”

According to the researchers, the success of FABULAS has led to a larger randomised trial called ‘WAVE’, where they are comparing Triple T with traditional adrenal surgery in 120 patients and the results are expected in 2027.

The experts highlighted that millions of people suffering from undiagnosed primary aldosteronism now have new hope due to the research and with the ongoing studies, treatment could soon become a standard procedure globally, revolutionising care for patients with this treatable form of hypertension.