A new type of scan may help doctors find a hidden and potentially curable cause of high blood pressure.
The test can identify tiny growths in the adrenal glands that produce too much of a hormone called aldosterone.
The research was led by scientists and doctors from Queen Mary University of London, Barts Hospital, and Cambridge University Hospital. The findings were published in the journal Nature Medicine.
High blood pressure, also called hypertension, is extremely common and increases the risk of heart attack, stroke, kidney disease, and other serious health problems. Most patients control it with medicines, but doctors cannot always identify the exact reason their blood pressure is too high.
For some people, the problem begins in the adrenal glands, two small organs that sit above the kidneys. These glands make several important hormones, including aldosterone, which helps the body control salt, water, and blood pressure.
When an adrenal gland makes too much aldosterone, the body holds on to extra salt and water. This can raise blood pressure and can make hypertension particularly difficult to control with standard medicines.
In many cases, the excess hormone comes from a tiny, harmless nodule in just one adrenal gland. If doctors can prove that one gland is responsible, surgery to remove it may greatly improve blood pressure and can sometimes allow a patient to stop taking blood pressure medicine.
Finding these nodules has been difficult because they can be too small to identify reliably with ordinary CT scans. Doctors have traditionally relied on a more complicated procedure that involves placing thin tubes into veins near the adrenal glands and taking blood samples.
This catheter-based test is invasive, technically difficult, and available only at specialist centers. It can also fail to provide a clear result, which limits the number of patients who can be properly investigated.
The new approach combines CT imaging with a small amount of a radioactive tracer called metomidate. The tracer binds to tissue involved in making adrenal hormones, causing an overactive area to become visible on the scan.
Researchers tested the method in 128 people whose high blood pressure was linked to excessive aldosterone. They found that about two-thirds had excess hormone production coming from a benign nodule in only one adrenal gland.
The scan successfully provided useful images for every patient in the study and was quicker and easier for patients than the catheter procedure. This could make it much simpler to identify people whose hypertension has a treatable hormonal cause.
The researchers also combined the scan results with a urine test. Together, the tests correctly identified 18 of 24 patients who later had normal blood pressure without medication after surgery to remove the affected adrenal gland.
Professor Morris Brown, a co-senior author, explained that these nodules are often very small and may look normal on a standard CT image. The new tracer makes the hormone-producing tissue stand out, helping doctors see which adrenal gland is causing the problem.
The discovery is important because excessive aldosterone may account for a meaningful share of hypertension cases, yet many patients are never tested for it. Without a diagnosis, they may continue taking several blood pressure medicines while the underlying cause remains untreated.
The new scan is not a cure by itself, and not every person with high blood pressure will benefit from adrenal surgery. Patients still need careful testing to determine whether excess aldosterone is involved and whether one gland is mainly responsible.
If the technique becomes more widely available, however, it could move hypertension treatment toward a more personalized approach. For some patients, doctors may be able to find the biological cause of their high blood pressure and treat that cause directly rather than relying only on lifelong medication.
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