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  • Review Article
  • Special Issue: Current evidence and perspectives for hypertension management in Asia
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Selective venous sampling for secondary hypertension

Hypertension Research (2024)Cite this article

Abstract

Selective venous sampling (SVS), an invasive radiographic procedure that depends on contrast media, holds a unique role in diagnosing and guiding the treatment of certain types of secondary hypertension, particularly in patients who may be candidates for curative surgery. The adrenal venous sampling (AVS), in particular, is established as the gold standard for localizing and subtyping primary aldosteronism (PA). Throughout decades of clinical practice, AVS could be applied not only to PA but also to other endocrine diseases, such as adrenal Cushing syndrome (ACS) and Pheochromocytomas (PCCs). Notably, the application of AVS in ACS and PCCs remains less recognized compared to PA, with the low success rate of catheterization, the controversy of results interpretation, and the absence of a standardized protocol. Additionally, the AVS procedure necessitates enhancements to boost its success rate, with several helpful but imperfect methods emerging, yet continued exploration remains essential. We also observed renal venous sampling (RVS), an operation akin to AVS in principle, serves as an effective means of diagnosing renin-dependent hypertension, aiding in the identification of precise sources of renin excess and helping the selection of surgical candidates with renin angiotensin aldosterone system (RAAS) abnormal activation. Nonetheless, further basic and clinical research is needed.

Selective venous sampling (SVS) can be used in identifying cases of secondary hypertension that are curable by surgical intervention. Adrenal venous sampling (AVS) and aldosterone measurement for classificatory diagnosis of primary aldosteronism (PA) are established worldwide. While its primary application is for PA, AVS also holds the potential for diagnosing other endocrine disorders, including adrenal Cushing’s syndrome (ACS) and pheochromocytomas (PCCs) through the measurements of cortisol and catecholamine respectively. In addition, renal venous sampling and renin measurement can help to diagnose renovascular hypertension and reninoma.

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Funding

This work was supported by the Natural Science Foundation of Shandong Province (Grant nos. ZR2021MH039, ZR2015HL006, 2012YD18051), Clinical Science and Technology Innovation Program (Grant no. 202019089), and Major Project of Shandong University (Grant no. qlyxjy-201830).

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  1. These authors contributed equally: Chang Liu, Fei Zheng.

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  1. Department of Cardiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, 16766 Jingshi Road, 250014, Jinan City, China

    Chang Liu, Fei Zheng, Xinyu Zhang, Jinyu Pan, Wenyuan Ding & Xiuqing Tian

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Liu, C., Zheng, F., Zhang, X. et al. Selective venous sampling for secondary hypertension. Hypertens Res (2024). https://doi.org/10.1038/s41440-024-01699-3

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