CHina Adrenal Venous saMPling InvestigatiON

Primary aldosteronism (PA) is one of the most common causes of secondary hypertension, yet its optimal diagnostic and therapeutic strategies remain challenging. Adrenal venous sampling (AVS) is regarded as the gold standard for subtype differentiation; however, important clinical, technical, and methodological issues have not been systematically addressed. This study is designed to comprehensively evaluate AVS and its clinical implications, aiming to elucidate the relationship between AVS-guided diagnosis and management of PA and long-term clinical and biochemical outcomes, while refining AVS protocols, standardizing clinical practice, optimizing therapeutic decision-making, and ultimately improving patient management and prognosis.

Patients with Primary Aldosteronism (PA) undergoing Adrenal Venous Sampling via antecubital approach or femoral approach to discriminate PA forms with unilateral from bilateral excess aldosterone production.

Procedure: adrenal venous sampling

Patients with Primary Aldosteronism (PA) undergoing Adrenal Venous Sampling via antecubital approach or femoral approach to discriminate PA forms with unilateral from bilateral excess aldosterone production.

Plazo: 1 year after AVS procedure

Incidence of major adverse cardiovascular events (MACE) at 1-year follow-up, including stroke, heart failure, severe arrhythmias, renal failure, myocardial infarction, and death.

Plazo: At AVS procedure

Successful sampling will be defined by high selectivity index (cortisol in the adrenal vein/cortisol in inferior vena cava \>2 without ACTH simulation)

Plazo: At AVS procedure

Successful sampling will be defined by high selectivity index (cortisol in the adrenal vein/cortisol in inferior vena cava \>2 without ACTH simulation)

Plazo: At AVS procedure

Successful sampling will be defined by high selectivity index (cortisol in the adrenal vein/cortisol in inferior vena cava \>2 without ACTH simulation)

Plazo: At AVS procedure

Types of catheter at the time of Adrenal Venous Sampling via antecubital approach or femoral approach

Plazo: At AVS procedure

Time of the procedure

Plazo: At AVS procedure

Time of fluoroscopy

Plazo: At AVS procedure

The contrast agent dosage

Plazo: 1 week after AVS procedure

Complications related to adrenal vein cannulations (adrenal vein hematoma, inferior vena cava dissection, puncture site hematoma, etc)

Plazo: At AVS procedure

the cost of the procedure

Plazo: At 1, 3, 6, 12, and 18 months; and 2, 3, 4, 5, and 10 years after treatment

The difference in average systolic blood pressure measured by 24-hour ambulatory blood pressure monitoring (ABPM) between baseline and each follow-up time point.

Plazo: At 1, 3, 6, 12, and 18 months; and 2, 3, 4, 5, and 10 years after treatment

The difference in average diastolic blood pressure measured by 24-hour ambulatory blood pressure monitoring (ABPM) bewteen baseline and each follow-up time point.

Plazo: At 1, 3, 6, 12, and 18 months; and 2, 3, 4, 5, and 10 years after treatment

The difference in systolic blood pressure measured during clinic visits (office blood pressure) between baseline and each follow-up time point

Plazo: At 1, 3, 6, 12, and 18 months; and 2, 3, 4, 5, and 10 years after treatment

The difference in diastolic blood pressure measured during clinic visits (office blood pressure) between baseline and each follow-up time point

Plazo: At 1, 3, 6, 12, and 18 months; and 2, 3, 4, 5, and 10 years after treatment

The change in the number and/or dosage of antihypertensive medications taken by patients between baseline and each follow-up time point

Plazo: At 1, 3, 6, 12, and 18 months; and 2, 3, 4, 5, and 10 years after treatment

The difference in urinary albumin-to-creatinine ratio measured at baseline and at each follow-up time point

Plazo: At 1, 3, 6, 12, and 18 months; and 2, 3, 4, 5, and 10 years after treatment

The change in left ventricular mass index, as assessed by echocardiography, from baseline to each follow-up time point.

Plazo: At 1, 3, 6, 12, and 18 months; and 2, 3, 4, 5, and 10 years after treatment

The change in pulse wave velocity measured between baseline and each follow-up time point。

Plazo: At 6, 12, and 18 months; and 2, 3, 4, 5, and 10 years after surgery

Clinical outcomes will be assessed at each follow-up visit afteradrenal surgery according to the PASO consensus criteria. Outcomes will be categorized as:

(1)Complete clinical success: normal blood pressure without the need for any antihypertensive medication. (2)Partial clinical success: improvement in blood pressure and/or a reduction in the number or dosage of antihypertensive medications. (3)Absent clinical success: no improvement in blood pressure or antihypertensive medication burden.

Plazo: At 6, 12, and 18 months; and 2, 3, 4, 5, and 10 years after surgery

Biochemical outcomes will be assessed at each follow-up visit after adrenal surgery according to the PASO consensus classification. Outcomes will be categorized as:(1)Complete biochemical success: normal serum potassium levels and a normalized aldosterone-to-renin ratio (ARR) without the need for potassium supplementation.(2)Partial biochemical success: improvement in biochemical parameters without full normalization.(3)Absent biochemical success: no improvement in biochemical markers compared to baseline.

Plazo: At 6 and 18 months; and 2, 3, 4, 5, and 10 years after AVS procedure

Incidence of major adverse cardiovascular events (MACE), including stroke, heart failure, severe arrhythmias, renal failure, myocardial infarction, and death.

China Adrenal Venous Sampling Investigation: A National Multicenter Study