Beyond Drugs and Surgery: Superselective Adrenal Artery Embolization Redefines Primary Aldosteronism Management-A Systematic Review and Meta-Analysis.

BACKGROUND

Primary aldosteronism (PA) is a leading cause of secondary hypertension associated with increased cardiovascular and cerebrovascular risk. Superselective adrenal artery embolization (SAAE) has emerged as a minimally invasive alternative to adrenalectomy and mineralocorticoid receptor antagonists (MRAs). This systematic review and meta-analysis evaluates the efficacy and safety of SAAE in PA management.

METHODS

We searched PubMed, Web of Science, Embase, and Cochrane Library through June 2026 for studies enrolling patients with PA treated by SAAE. Outcomes of interest were changes in blood pressure (BP), biochemical markers (serum potassium, aldosterone, renin activity, and aldosterone-to-renin ratio), clinical and biochemical response rates, daily defined dose change, and adverse events. Data were pooled using a random-effects model.

RESULTS

Nineteen studies comprising 1242 patients undergoing SAAE met inclusion criteria. SAAE achieved substantial BP reductions: office systolic BP -19.71 mmHg (p < 0.001), office diastolic BP -10.91 mmHg (p < 0.001), home systolic BP -18.58 mmHg (p < 0.001), and 24-h ambulatory systolic BP -14.57 mmHg (p < 0.001). Serum potassium increased +0.34 mmol/L (p < 0.001), aldosterone declined -46.72 ng/dL (p < 0.001), and ARR decreased -32.64 (p < 0.001). Complete clinical response occurred in 27% and partial response in 43%; complete biochemical success was achieved in 48% with partial success in 16%. Antihypertensive burden decreased (-0.52 daily defined dose; p < 0.001). Adverse events were predominantly minor (postprocedural pain 37.17%, low-grade fever 8.55%); serious complications were uncommon (< 1%).

CONCLUSIONS

SAAE is an effective and somewhat safe treatment for PA that achieves meaningful BP control, biochemical normalization, and reduced medication burden. It represents a valuable option for patients ineligible for or intolerant of surgery or MRAs.