A groundbreaking treatment could free millions from lifelong blood pressure medication. UK researchers developed a 20-minute heat-based therapy to target adrenal nodules, offering a safer option to surgery.
Doctors at Queen Mary University of London, Barts Health NHS Trust, and University College London introduced this minimally invasive approach. Called Targeted Thermal Therapy (Triple T), it promises a major shift in treating an overlooked hormonal condition. Published in The Lancet, this technique could change the lives of millions worldwide.
A HIDDEN CAUSE OF HIGH BLOOD PRESSURE
High blood pressure affects one in three adults. Yet, one in 20 cases stems from primary aldosteronism, a condition caused by adrenal nodules producing excess aldosterone. This hormone raises blood pressure by increasing salt levels in the body.
Most cases remain undiagnosed, with fewer than one percent receiving treatment. Patients with this condition often struggle with standard blood pressure medications. They face higher risks of heart attacks, strokes, and kidney failure.
A GAME-CHANGER IN TREATMENT
Until now, surgery was the only cure. Removing the entire adrenal gland required general anesthesia, a hospital stay, and weeks of recovery. Many patients avoided treatment due to its complexity.
Triple T changes this. The procedure selectively destroys adrenal nodules without removing the gland. Advances in diagnostic scans help locate these tiny nodules, allowing precise treatment. For left adrenal nodules, the stomach provides direct access.
HOW TRIPLE T WORKS
Triple T adapts two proven techniques—radiofrequency and microwave energy—to generate heat. A small needle delivers controlled bursts to burn the malfunctioning tissue while sparing healthy cells.
Like routine endoscopy, doctors insert a tiny internal camera through the mouth into the stomach. The ultrasound-guided needle then targets the nodule. In just 20 minutes, the procedure eliminates the need for internal or external incisions.
PROMISING TRIAL RESULTS
Researchers tested Triple T in the FABULAS study—short for Feasibility study of radiofrequency endoscopic Ablation, with Ultrasound guidance, as a non-surgical Adrenal Sparing treatment for aldosterone-producing adenomas.
FABULAS involved 28 patients with primary aldosteronism. Molecular scans pinpointed hormone-producing nodules in their left adrenal glands. The results were impressive. Most participants had normal hormone levels six months later. Many stopped taking blood pressure medications, with no relapse of their condition.
Professor Morris Brown, a co-senior author of the study, emphasized its significance. “It has been 70 years since the discovery of aldosterone. Today, we are realizing the potential to identify and treat these curable nodules with 21st-century breakthroughs.”
A PATIENT’S PERSPECTIVE
Michelina Alfieri, one of the trial participants, shared her experience. “I suffered from debilitating headaches for years despite multiple doctor visits. As a full-time worker and single parent, my daily life was affected. This treatment provided immediate recovery. I returned to my routine right away. I’m incredibly grateful.”
WHAT’S NEXT?
Following FABULAS’s success, researchers launched a larger trial called “WAVE.” This study will compare Triple T with traditional adrenal surgery. Results are expected in 2027.
Professor Stephen Pereira, Chief Investigator of FABULAS, sees global potential. “With proper training, this technique could be widely available in endoscopy units worldwide.”
Professor Mark Gurnell of the University of Cambridge highlights the importance of advanced imaging. “New PET tracer molecules allow us to diagnose and precisely treat adrenal nodules for the first time. This could help thousands of people lower their cardiovascular risks and reduce their dependency on blood pressure medication.”
A MAJOR STEP FORWARD
For millions with undiagnosed primary aldosteronism, this treatment brings new hope. By replacing major surgery with targeted heat therapy, it offers faster recovery and better outcomes. With larger trials underway, Triple T could soon become a standard procedure worldwide, transforming hypertension treatment.
The research was funded by Barts Charity, the National Institute for Health and Care Research (NIHR), and the British Heart Foundation.
