[HN Gopher] A new scan to detect and cure the commonest cause of...
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A new scan to detect and cure the commonest cause of high blood
pressure
Author : gmays
Score : 124 points
Date : 2023-01-17 19:15 UTC (3 hours ago)
(HTM) web link (www.qmul.ac.uk)
(TXT) w3m dump (www.qmul.ac.uk)
| yjftsjthsd-h wrote:
| Hilariously, I think the HN anti-clickbait filter made this title
| _more_ clickbaity: The original title was "Ten-minute scan
| enables detection and cure of the commonest cause of high blood
| pressure", which HN _helpfully_ removed the number from...
| leading to "Minute scan detects and cures of most common cause
| of high blood pressure". And a _one_ minute scan would be even
| more impressive, but that 's not what it is...
| dang wrote:
| Yes, that happens sometimes.
|
| I've changed it to clearer language from the first paragraph.
| QuercusMax wrote:
| The current title is also wrong: it's _not_ a CT scan, but
| rather a PET /CT scan (with the emphasis on the PET, which
| requires injection with a radiotracer).
| dang wrote:
| Ok, maybe it's safest to just drop the CT. Thanks!
| LinuxBender wrote:
| They should still have some time to edit the description. If
| that time is exceeded they could email dang and ask to edit.
| The filter only happens on submission but not on edit.
| ipqk wrote:
| I interpreted it as a minute scan (i.e. very small, of small
| importance). But it's a CT-scan which very much is not a minute
| scan.
| hinkley wrote:
| I was picturing someone with an electron microscope, scanning
| the most minute of things...
|
| But the rest of the shortened title is straight-up hashbrowns.
| You are fixing a common problem with a scan? That's not how
| medicine works.
| VLM wrote:
| 1 in 20 is "most"? What about the other 19 in 20?
|
| I was under the impression that the most common cause was being
| fat.
| sp332 wrote:
| "Most common cause", singular.
| joshenders wrote:
| Was looking for this comment, thank you.
| [deleted]
| kashunstva wrote:
| The vast majority of arterial hypertension is "essential
| hypertension," meaning no identifiable cause. I assume this is
| (misleadingly) saying that of the secondary (non-essential)
| hypertension cases, the condition that this scan detects is the
| most common.
| CoastalCoder wrote:
| Interesting. I thought "idiopathic" was the only medical term
| for "I don't know why."
| r00fus wrote:
| From TFA:
|
| " 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."
|
| So it seems that 2/3 of the cause of HBP is elevated
| aldosterone, but 1/20 of cases this can be fixed with a not-so-
| invasive procedure.
| 1024core wrote:
| Nature article:
| https://www.nature.com/articles/s41591-022-02114-5
| aantix wrote:
| I had my left adrenal gland taken out in September.
|
| TL;DR - If you know someone that takes a lot of blood pressure
| medications and has for many years, have them see an
| endocrinologist and get them screened for hyperaldosteronism (
| aka Conn's syndrome ).
|
| Kind of a crazy story.
|
| I've had blood pressure (BP) issues since my senior year of high
| school. 1996. Started taking my first medication then.
|
| Since then, I've had one hospital stay, 3 ER visits, yearly
| checkups, all because my blood pressure is really hard to
| control.
|
| I've seen 3 cardiologists and two nephrologists over these past
| 25 years to help me manage my BP.
|
| I figured the high BP was because I was fat.
|
| I think my highest bp reading ever was 210/130. I'd commonly see
| 170/110. Not good.
|
| These past couple of years, my blood pressure had gotten and
| stayed really, really high. To the point where I was waking up
| with headaches. I even had a few headaches where I thought I was
| going to have a stroke.
|
| Fast forward to my most recent blood pressure related ER visit (
| in March ) - the cardiologist raises the dose on yet another
| medication. I'm like "WTF is going here? This is craziness. I
| can't keep taking all of these medications."
|
| Really frustrated, I do my own research. I stumble upon a couple
| of studies citing Pheochromocytomas, a tumor on the adrenal that
| secretes excessive hormones which causes an elevation in blood
| pressure.
|
| Then I read a Washington Post article talking about a guy on "a
| bucketload of blood pressure medications" that actually ends up
| having a tumor on his adrenal gland.
|
| The general condition is called Hyperaldosteronism. This is the
| condition discussed in the parent article.
|
| It's pretty rare - like 1/1000. You basically have an adrenal
| glad that secretes too much Aldosterone which drives the bodily
| retention of salt and water. Which in turn, chronically elevates
| blood pressure while abnormally dumping potassium.
|
| At my next cardiologist appt, the Dr. basically tells me "I have
| nothing else for you". He wanted to increase my four blood
| pressure medications, again. He thought I should go back to see
| the nephrologist.
|
| Given my research, I asked him for a referral to the
| endocrinologist. For which he annoyingly shrugs, "sure, why not.
| But they're usually booked way out." I get a call from the
| endocrinologist the following Monday. I get in right away. I
| mention Hyperaldosteronism. Tell them my long history with
| resistant hypertension. They totally agree. They setup an
| appointment for a blood screening.
|
| Sure enough, the tests come back with really elevated levels of
| aldosterone, really low levels of renin, and really low potassium
| levels. All signatures of hyperaldosteronism.
|
| They then do an AVS, a vascular sampling of the blood coming out
| of each adrenal. It showed overwhelmingly my left adrenal
| produces high volumes of aldosterone with low levels of renin.
| The left adrenal's Aldosterone/renin ratio demonstrated that it
| was the dominant one.
|
| Which is actually good, because then I could have my left adrenal
| taken out, and still live very normally with the right adrenal
| taking over.
|
| So that's how my surgery came about. My overactive adrenal has
| probably been a huge contributor of my elevated blood pressure,
| for many, many years.
|
| The pathology report came back and they did find a nodule in my
| left adrenal gland, that was not visible from the initial CT
| scan.
|
| https://www.washingtonpost.com/health/2022/04/23/high-blood-...
|
| P.S. The Facebook group for Conn's Syndrome is a wealth of a
| knowledge and has a few really amazing members that can guide you
| on how to navigate getting tested (a lot of doctor's aren't
| necessarily aware of the condition).
| https://www.facebook.com/groups/652067311558303
| xiande04 wrote:
| Glad you got it figured out and solved! I hate it when doctors
| refuse to listen to you.
| aantix wrote:
| It's strange how much difference a year can make.
|
| I went from taking four BP medications, feeling like I would
| have a stroke in the next year and would probably die.
|
| To now - I'm on a single BP medication (lisinipril), I've
| lost 40 pounds (Mounjaro), and am optimistic about my long
| term health.
| secondcoming wrote:
| And what happened? Did your blood pressure return to normal?
| Did the years of medication have any permanent side effects?
| aantix wrote:
| I still take one BP medication - 40mg of Lisinopril. My blood
| pressure numbers are much more "normal" - usually around
| 135/85.
|
| I seem to be caffeine sensitive in general. On days where I
| drink caffeine, my BP is ~15 points higher on the systolic
| side. It lasts the entire day. I may be a slow metabolizer.
|
| I've had a ton of anxiety over the years that seems to have
| vanished with the adrenalectomy. I was always on edge - like
| I could jump out of my skin. And after the operation, that
| has vanished.
|
| When I had the hyperaldosteronism, I started to experience
| these "thunderclap headaches" - where I would suddenly get a
| super-intense headache on the verge of a stroke. They were
| awful.
|
| Those have gone away as well.
| another_story wrote:
| With the anxiety did you also have palpitations or
| arrhythmia? I'm having a similar problem.
| aantix wrote:
| Yes, lots of palpitations. To the point where I wore a
| monitor for a few days so that my cardiologist could
| evaluate.
|
| With hyperaldosteronism, because your body retains elevated
| levels of sodium, it dumps potassium. This is probably the
| main cause of the palpitations.
|
| Low potassium is a marker for hyperaldosteronism.
| dr_dshiv wrote:
| I hope they make a lot of money. That's a pretty fantastic
| system.
| lol768 wrote:
| The work was funded by the NIHR (i.e. the UK taxpayer); the
| primary purpose is patient benefit to users of the NHS, not
| profit. If they're making a disproportionate "lot of money",
| there should be a signed revenue-sharing agreement in place
| given the benefit of the public funds provided.
| harveywi wrote:
| For those who may not have access to this treatment, an
| alternative is to add the following to /etc/hosts:
| 127.0.0.1 facebook.com 127.0.0.1 www.facebook.com
| 127.0.0.1 twitter.com 127.0.0.1 www.twitter.com
| zamadatix wrote:
| Better to use 0.0.0.0 and have it immediately return an error
| than try to connect to localhost.
| tootie wrote:
| Bad joke. Social media can not cause chronic hypertension. It's
| physiological.
| jessriedel wrote:
| Tangent: "Commonest" is listed in the dictionary as an acceptable
| alternative to "most common", but I can't recall ever hearing it
| before. According to Ngram the latter is 20 times more common (or
| commoner, heh) but I would still have expected to remembering
| hearing it. Is this a UK vs. US thing?
| harveywi wrote:
| It seems you have identified the second commonest cause of high
| blood pressure.
| mouse_ wrote:
| good post
| jessriedel wrote:
| Journal article: Wu et al., "11C-metomidate PET CT versus Adrenal
| Vein Sampling for diagnosing surgically curable primary
| aldosteronism: prospective test validation, and impact of somatic
| genotype and ethnicity on outcomes"
|
| https://assets.researchsquare.com/files/rs-1179128/v1_covere...
|
| Metomidate is a molecule (C_13 H_14 N_2 O_2) that naturally
| collects in the adrenal glands, and 11C-metomidate is a version
| where some of the carbon atoms are carbon-11, a radioactive
| version that will show up on PET-CT scans.
|
| https://en.wikipedia.org/wiki/Metomidate
|
| For reference, a PET-CT scan costs $1k-$10k in the US. Not sure
| how much the radioactive tracer adds.
| pfdietz wrote:
| That tracer has to be made on site, since 11C has a halflife of
| 20 minutes. So there has to be a particle accelerator to make
| the 11C and a chemistry lab to quickly get the 11C into the
| drug.
| akomtu wrote:
| Looks like the cure is surgery, and with the sorry state of the
| US healthcare, that's hardly a solution.
| Traubenfuchs wrote:
| I completely agree. Running the numbers in my head that would
| be up to 10 million patients this surgery would be relevant for
| in the US.
| vjk800 wrote:
| Can someone who knows more about the field to comment on whether
| this is as revolutionary as it sounds?
| Traubenfuchs wrote:
| - this only concerns 5 - 10% of all hypertension patients
|
| - ~50% of adult Americans have hypertension
|
| - scanning all medication-non-responders (= people suffering
| from "resistant hypertension") and operating on all of them to
| remove the causative nodules sounds like quite the tall order
|
| - doctors won't just suddenly start sending all the resistant
| hypertension patients to CTs to diagnose this cause, instead
| they will continue to escalate their patients anti-hypertensive
| medication, i.e. adding an aldosterone antagonist to the three
| other maximum dosage blood pressure lowering medications the
| patient already takes.
|
| - this might become an option for people suffering from
| resistant hypertension that are receiving expensive, excellent
| state of the art treatment
| ClumsyPilot wrote:
| isn't a single CT scan and surgery cheaper than 40 years of
| medication?
| Traubenfuchs wrote:
| That small question is so complex, it could probably be
| elucidated in a complete high quality bachelor thesis.
|
| Many of those patients will continue to have high blood
| pressure for other reasons (obesity, fat intake, renal
| impairment, god knows what else) and will need to continue
| their medication, maybe they will downgrade (upgrade? (-; )
| from treatment resistant hypertension to normal
| hypertension. A significant amount of the patients
| receiving surgery will suffer from mild to severe bacterial
| infections that also need treatment.
|
| At the top of my head I would still say yes, it would be
| cheaper.
|
| ALSO and BUT: Please do not expect a treatment that is both
| cheaper and better for the quality of life of the patient
| to be chosen by default. Hospitals and doctors don't work
| that way.
| trynewideas wrote:
| The article/headline is confusing; the real comparison is
| between a non-invasive PET-CT scan using metomidate as an
| imaging medium, and invasive and specialized adrenal vein
| sampling (AVS), both as diagnostic tools.
|
| AVS is correlated using a non-metomidate adrenal CT scan
| anyway, so a CT-only option would be less expensive and
| could be performed in more facilities, making it more
| accessible:
|
| > Until now, 99% are never diagnosed because of the
| difficulty and unavailability of tests.
|
| And since AVS has such a low predictive success rate (63%
| per the study), the CT-scan-only alternative doesn't even
| have to be _good_ , it just has to be _about as bad_ as
| AVS.
|
| The results of either could very well be "keep taking meds
| for 40 years" or "surgery helps immensely", but the real
| cost savings are in avoiding AVS and also potentially
| diagnosing and treating more people sooner.
|
| (Also mind that the study's done in the UK, where CT scans
| cost patients about PS800/US$1,000 even when done
| privately, and in Scotland/Wales/N. Ireland the meds are
| free to the patient. In the US, a CT scan averages about
| $5,000, $12,000 isn't unheard of, and the meds cost
| $7,000-$20,000 for 40 years.)
| Rebelgecko wrote:
| Probably not. The sticker price of my blood pressure
| medicine comes out to like $60/yr. The scan alone would
| probably cost more than 40 years of medication (and the #s
| are potentially much worse if you consider time value of
| money and all that)
| golem14 wrote:
| Cost to you, or combined cost for you / insurer ? Honest
| question.
| mikeyouse wrote:
| Most blood pressure medication is dirt cheap, effective
| pills have been generic for decades now -- you can get a
| 3-month supply of the largest dose of lisinopril for
| under $10 cash (no insurance).
|
| https://costplusdrugs.com/medications/lisinopril-2_5mg-
| table...
| jabroni_salad wrote:
| It really depends on the surgery. Heart surgery isn't
| exactly minor and doctors do tend to prefer non-invasive
| treatment.
|
| I like to minimize on my needed medications though. I would
| probably opt for this if it were available.
| golem14 wrote:
| Isn't the described remedial procedure to take a
| radioactive substance that will burn out the nodules ?)
| That's not that expensive or invasive.
|
| I understand something similar is done for Morbus Basedow
| / Grave's disease with the thyroid gland.
| Traubenfuchs wrote:
| The linked article references "surgically curable primary
| aldosteronism".
|
| You are probably referencing "radioiodine therapy" which
| is highly specific to thyroid issues.
| themantalope wrote:
| Radiologist.
|
| It's cool, it's a nice study. The article definitely over hypes
| the "common cause of hypertension". These lesions are rare.
| Most people with high blood pressure have it because of
| metabolic disease/chronic stress/lifestyle, and it can be
| managed with changes to diet exercise and meds.
|
| It is true that doing adrenal vein sampling is hard and not
| always successful. Having a protocol that can non-invasively
| detect these lesions may save some people a procedure.
| fareed79 wrote:
| This is not a CT but a PET scan, it records passive radiation
| from a molecule injected into the body, and therefore a 10 min
| long scan. Then it is based on radioactive carbon (C-11), which
| is pretty uncommon and needs quick use after production, so not
| every PET(CT) can do that, it needs be in the vicinity of a
| production facility (i.e. close to a university/research
| hospital). This is the sense of the last sentence: it needs a
| replacement the carbon with another radioactive isotope (fluor
| for instance) to be doable at every PET/CT place. I don't blame
| the title here, because the article itself is very strangely
| written, it says as well "CT scan" but this is no "CT scan", this
| is a PET scan.
| selimthegrim wrote:
| I wonder if US healthcare with its profusion of CT scanners can
| drive down long term patient treatment costs faster with their
| greater installed base.
| SoftTalker wrote:
| I don't know about that. I currently need an MRI and the
| earliest appointment I could get was 4 weeks out, and that's
| not at the closest facility (they are nearly two months out).
| Maybe CT scans are faster.
| themantalope wrote:
| Radiologist.
|
| Depending on the protocol, CT scans usually take anywhere
| from 5 seconds to 10 minutes (in the longer scans most of
| that is waiting after contrast injection).
|
| MRI studies take a long time to acquire data, usually at
| least 20 minutes for very short/limited studies. More
| involved protocols can take hours. Patient throughput is
| slower.
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(page generated 2023-01-17 23:00 UTC)