Aprocitentan in hypertension management: clinical efficacy, safety, and future prospects

Hypertension (HTN) is a prevalent medical condition characterized by systolic blood pressure ≥ 130 mm Hg and diastolic blood pressure ≥ 80 mm Hg. In 2010, the global prevalence of HTN was 31.1%, with higher rates in men and low- and middle-income countries (LMICs). The etiology of primary HTN involves neurohumoral, renal, metabolic, genetic, and environmental factors, with the kidneys playing a significant role in long-term blood pressure regulation. Endothelin-1 (ET-1), a potent vasoconstrictor, contributes to HTN by affecting salt-water balance and promoting vascular remodeling. HTN often presents without symptoms, leading to complications such as heart failure, stroke, and renal failure if untreated. Common treatment options include angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, calcium channel blockers, and diuretics. Aprocitentan, a novel dual endothelin receptor antagonist, has shown promise in reducing blood pressure in patients with resistant HTN. Clinical trials, including the Phase 3 PRECISION study, demonstrated its efficacy and long-term control. However, Aprocitentan's use is associated with safety concerns, such as hepatotoxicity, fluid retention, and embryo-fetal toxicity, necessitating careful monitoring. Aprocitentan represents a significant advancement in HTN management, offering a new therapeutic option for patients with uncontrolled HTN, although vigilant monitoring and informed decision-making are essential to mitigate potential risks and ensure optimal outcomes.