Long-term Efficacy and Safety of Unilateral Adrenal Artery Embolization in Patients with Idiopathic Hyperaldosteronism: A 24-month Cohort Study

BACKGROUND: Adrenal artery embolization (AAE) has been shown to reduce blood pressure (BP) and correct biochemical abnormalities in patients with idiopathic hyperaldosteronism (IHA) during short-term 6-12-month follow-ups. This study aimed to evaluate the long-term efficacy and safety of unilateral AAE over a 24-month period. METHODS: The prospective study included 109 IHA patients undergoing unilateral AAE, with 94 completing the 24-month follow-up. Evaluations included office, home and 24-hour ambulatory BP, biochemical markers, renal function, and cardiac function (echocardiography). Medication use and adverse events were documented. RESULTS: At the 24-month follow-up, the office, home, and 24-hour ambulatory systolic BP values decreased by 17.3 ± 23.1, 16.4 ± 21.9, and 9.9 ± 18.6 mmHg, respectively (all P < 0.001), and the diastolic BP values decreased by 8.8 ± 16.1, 7.1 ± 15.8, and 6.4 ± 11.1 mmHg (all P < 0.001). The complete and partial clinical success rates were 14.9% and 50.0%, respectively, whereas those for biochemical success were 13.6% and 45.5%. Abnormal biochemical characteristics, including elevated plasma aldosterone levels, increased aldosterone‒renin ratios (ARRs), plasma renin suppression, and hypokalemia, were significantly improved (all P < 0.01). Improvements in cardiac remodeling and left ventricular (LV) diastolic function were observed, particularly in those with elevated LV mass index (P < 0.05). No evidence of renal impairment or long-term safety concerns was observed. CONCLUSION: Unilateral AAE in IHA patients promotes sustained BP reduction, biochemical correction, improved cardiac remodeling, and enhanced LV diastolic function over 24 months, with no significant long-term safety concerns.