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

High blood pressure, or hypertension, affects over 1.4 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 mild autonomous cortisol secretion (MACS, aka 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. Found in 3-10% of adults undergoing such scans, these tumors are often benign, but 30-50% cause mild autonomous cortisol secretion (MACS). 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 mild autonomous cortisol secretion (MACS, aka subclinical Cushing syndrome), removed by Dr. Carling.

CHIRACIC: A Landmark Study

Between 2015 and 2022, CHIRACIC enrolled 78 patients, randomizing 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, 52% of the surgical group (12 of 23 who completed the study) achieved normal systolic blood pressure without any drugs, while none in the conservative group did. 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.

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, the world’s most experienced adrenal surgeon, the center is the highest-volume adrenal surgery facility globally. Dr. Carling personally performs approximately 600 adrenal operations per year, whereas entire major U.S. university hospital centers, between all surgeons, perform 20-50 cases annually.

Patients travel from across the U.S. and over 10% from other countries for Dr. Carling’s expertise, drawn by high cure rates, low complication rates, 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 90% of U.S. adrenal surgeries are performed by surgeons doing four or fewer annually, leading to higher complications and suboptimal outcomes.

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. Preferred for >95% of adrenal surgeries, 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 and is common among less experienced surgeons, 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, making it safer and faster. Dr. Carling typically completes MBSA in less than 20-30 minutes, compared to 2-4 hours for LTA at other centers, minimizing anesthesia risks like nausea or blood clots.

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’s expertise ensures exceptional outcomes, with no reported injuries to surrounding organs or need for blood transfusions.

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—most surgeons, performing only a few adrenalectomies yearly, rely on outdated LTA or robotic methods, which Dr. Carling’s team avoids due to longer recovery times and higher risks.

Why This Matters

Hypertension is a global crisis, and lifelong medication adherence is a burden. CHIRACIC shows that for patients with MACS, adrenalectomy can halve the need for drugs, with over half achieving normal blood pressure without any. The Carling Adrenal Center amplifies this potential with MBSA, performed by a surgeon whose experience dwarfs that of most. 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 (function-preserving) adrenalectomy for many cases.

If you have hypertension and an adrenal incidentaloma, consult an endocrinologist for MACS testing. 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 May 12, PMID: 40373786.

Additional Resources: 

• Learn more about the Carling Adrenal Center
• Learn more about Dr. Tobias Carling
• Learn more about our sister surgeons at the Norman Parathyroid Center, and Clayman Thyroid Center.
• Learn more about the Hospital for Endocrine Surgery