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Can Surgery Cure High Blood Pressure? A Breakthrough Study and the Role of Expert Adrenal Surgery

Can Surgery Cure High Blood Pressure? A Breakthrough Study and the Role of Expert Adrenal Surgery

High blood pressure, or hypertension, affects more than a billion people worldwide, silently increasing risks of heart disease, stroke, and kidney failure. For most, it’s a lifelong condition managed with medications and lifestyle changes. However, a groundbreaking study called CHIRACIC, published in May 2025, suggests that for patients with unilateral adrenal incidentalomas and adrenal hypercortisolism (AHC), formerly called mild autonomous cortisol secretion (MACS) or subclinical Cushing syndrome, surgery could significantly reduce or even eliminate the need for antihypertensive drugs. Coupled with the expertise of the Carling Adrenal Center and its pioneering Mini Back Scope Adrenalectomy (MBSA) technique, this approach offers new hope for select patients. This blog explores the CHIRACIC findings, the critical role of expert surgeons, and why the MBSA method is a game-changer.

The Silent Tumors Driving Hypertension

Adrenal incidentalomas are tumors in the adrenal glands—small, hormone-producing organs atop the kidneys—discovered unexpectedly during imaging for unrelated issues, like abdominal pain. These tumors are common and usually benign, but many of them cause mild autonomous cortisol secretion (MACS), which is the most common hormone excess found in incidentalomas. MACS leads to low-level, unregulated cortisol production, a hormone that, in excess, raises blood pressure, disrupts metabolism, and increases cardiovascular risk. Many patients with MACS have hypertension, but until recently, it was unclear whether removing the tumor via adrenalectomy could resolve this issue, and to what extent.

The CHIRACIC study, led by Dr. Antoine Tabarin and conducted across 17 university hospitals in France, Italy, and Germany, set out to answer this question. Published in The Lancet Diabetes & Endocrinology, it’s a multicenter, randomized controlled trial—the gold standard in medical research—designed to compare adrenalectomy with conservative management in patients with unilateral adrenal incidentalomas and MACS.

Figure 1: A typical cortisol-producing adrenal adenoma (2.5 cm), causing adrenal hypercortisolism (AHC; formerly called MACS or subclinical Cushing syndrome), removed by Dr. Carling.

CHIRACIC: A Landmark Study

Between 2015 and 2022, CHIRACIC randomized 52 eligible participants (median age 63 years, 69% female) into two groups: 26 underwent adrenalectomy, and 26 received conservative management (medications and monitoring). To ensure precision, researchers confirmed hypertension using home blood pressure measurements (HBPM) and standardized antihypertensive treatment before the trial. Patients were followed for 13 months, with systematic efforts to reduce medications when possible.

The primary endpoint was the proportion of patients achieving normal blood pressure (per HBPM) while reducing antihypertensive drugs. Secondary endpoints included 24-hour ambulatory blood pressure monitoring (ABPM), changes in medication intensity, and the proportion of patients still needing antihypertensive drugs.

The results were striking. At the study’s end, 46% of the adrenalectomy group (12 of 26) had normal blood pressure and reduced their medications, compared to just 15% (4 of 26) in the conservative group (adjusted risk difference 0.34, 95% CI 0.11 to 0.58, p=0.0038). Remarkably, about half of the surgical group achieved normal systolic blood pressure without any drugs, while almost all patients in the conservative group still needed them. The surgical group also required less intense medication regimens (average treatment step 0.8 vs. 3.0, adjusted difference -2.05, 95% CI -2.61 to -1.50, p<0.0001). ABPM confirmed smaller but consistent improvements in systolic blood pressure for the surgical group. Surgery was not risk-free: surgery-related serious adverse events occurred in 13% of the surgical patients in the trial.

Why Expertise Matters: The Carling Adrenal Center

The CHIRACIC study highlights the potential of adrenalectomy, but its success hinges on surgical expertise. Adrenal surgery is complex, with risks of complications if not done expertly. This is where the Carling Adrenal Center in Tampa, Florida, stands out. Founded by Dr. Tobias Carling, one of the world’s most experienced adrenal surgeons, the center is one of the highest-volume adrenal surgery centers in the world. Dr. Carling personally performs every operation, up to 750 adrenal operations a year, whereas the typical surgeon who performs adrenal surgery does about one adrenal operation per year.

About half of our patients come from outside Florida, including from around the world, drawn by Dr. Carling’s expertise and a patient-centered approach. The center’s philosophy emphasizes “peace of mind,” ensuring patients are treated by a surgeon who performs adrenalectomies daily, not a few times a year. This is critical, as more than 80% of adrenalectomies in the United States are performed by low-volume surgeons, and outcomes are better with surgeons who do the operation regularly.

The Mini Back Scope Adrenalectomy (MBSA): A Surgical Revolution

The CHIRACIC study doesn’t specify surgical techniques, but the Carling Adrenal Center’s Mini Back Scope Adrenalectomy (MBSA) aligns perfectly with its findings, particularly for MACS-related hypertension. Used for more than 95% of our operations, including those for Cushing’s syndrome and hypercortisolism (like MACS), MBSA is a minimally invasive technique using three small incisions in the lower back.

Unlike traditional laparoscopic transabdominal adrenalectomy (LTA), which goes through the front of the abdomen, MBSA accesses the adrenal gland directly in the retroperitoneal space, avoiding abdominal organs and scar tissue from prior surgeries. This reduces the risk of injury to the kidney, liver, or pancreas, and eliminates the need to reposition patients during bilateral procedures, which in our experience makes it safer and faster. Dr. Carling typically completes MBSA in about 20 minutes, and a short operation keeps anesthesia risks like nausea or blood clots low.

MBSA’s benefits include:

  • Minimal Scarring: Small incisions leave barely visible scars, unlike larger cuts in open surgery.
  • Faster Recovery: Patients often go home the same day and return to normal activities quickly.
  • Less Pain: The minimally invasive approach reduces post-operative discomfort.
  • High Success Rate: Dr. Carling performs this operation every day, and outcomes are better with surgeons who do it regularly.

For MACS patients, MBSA is ideal because it precisely removes the cortisol-secreting tumor, directly addressing the hypertension driver, as CHIRACIC demonstrated. However, MBSA requires advanced skill and regular practice. Many surgeons who perform only a few adrenalectomies yearly use LTA or robotic methods; in our view, these add operating time and cost without added benefit for most adrenal tumors.

Why This Matters

Hypertension is a global crisis, and lifelong medication adherence is a burden. CHIRACIC shows that for patients with MACS, adrenalectomy can greatly reduce the need for drugs, with about half achieving normal blood pressure without any. The Carling Adrenal Center builds on this potential with MBSA, performed by one of the world’s most experienced adrenal surgeons. For patients with incidentalomas, often dismissed as harmless, this combination of evidence and expertise could mean a cure, not just management.

What’s Next?

CHIRACIC’s small sample (52 patients) calls for larger studies to confirm its findings and explore long-term benefits, like reduced heart attacks or strokes. Questions remain about patients with bilateral incidentalomas or severe cortisol secretion. Meanwhile, the Carling Adrenal Center continues to innovate, offering one-visit diagnostic and surgical programs and advancing techniques like partial (adrenal-sparing) adrenalectomy for many cases.

If you have hypertension and an adrenal incidentaloma, ask your doctor for MACS testing (a 1-mg overnight dexamethasone suppression test, with ACTH and DHEA-S). If surgery is an option, seek a center like the Carling Adrenal Center, where expertise and MBSA maximize your chances of success. As CHIRACIC and Dr. Carling’s work shows, a one-time procedure could replace years of pills and poor quality of life, transforming lives and redefining hypertension treatment.

Reference

Tabarin A, et. al. Surgery for the treatment of arterial hypertension in patients with unilateral adrenal incidentalomas and mild autonomous cortisol secretion (CHIRACIC): a multicentre, open-label, superiority randomised controlled trial. Lancet Diabetes Endocrinol. 2025;13(7):580-590. PMID: 40373786.

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Author

Dr. Tobias Carling MD, PhD, FACS

Dr. Tobias Carling is a world-recognized endocrine surgeon and adrenal surgery expert, widely regarded as one of the highest-volume adrenal surgeons in the United States and globally. He is the Founder and Surgeon-in-Chief of the Carling Adrenal Center in Tampa, Florida, an international referral center dedicated exclusively to adrenal tumors and adrenal hormone disorders. Prior to founding the Carling Adrenal Center, Dr. Carling spent 17.5 years at Yale University School of Medicine, where he served as Chief of Endocrine Surgery, Associate Professor of Surgery, Endocrine Surgery Fellowship Director, and Founder of the Yale Endocrine Neoplasia Laboratory. His work helped advance the understanding and treatment of adrenal, thyroid, and parathyroid tumors. Dr. Carling specializes in advanced minimally invasive adrenal surgery, including complex and function-preserving adrenalectomy techniques. He holds both an MD and PhD from Uppsala University in Sweden and has published extensively in leading scientific journals, including The New England Journal of Medicine, Nature, Science, and PNAS. He is a Fellow of the American College of Surgeons (FACS) and a member of the American Association of Endocrine Surgeons and the International Association of Endocrine Surgeons. Patients from across the U.S. and around the world seek his expertise for complex adrenal disease.