Effects of aprocitentan on prognostically relevant ambulatory blood pressure-derived variables in resistant...

Ambulatory blood pressure measurement (ABPM) data from the PRECISION study have shown that in patients with confirmed resistant hypertension (RHT), aprocitentan leads to substantial lowering of BP, particularly at night-time. Here, the ABPM data were used to define subgroups with substantial prognostic value (dipping pattern, BP load, heart rate, arterial stiffness, and salt sensitivity) and to evaluate the BP-lowering effect of aprocitentan on these subgroups.

The effects of aprocitentan on ABPM derivatives including dipping pattern, BP load, and heart rate were evaluated. The BP lowering effect of aprocitentan was assessed based on the subject's baseline arterial stiffness and salt sensitivity.

At week 4, the placebo-corrected and dose-dependent decrease of ambulatory systolic BP was more marked for baseline non-dippers than dippers. The proportion of non-dippers at baseline whose dipping pattern normalized at week 4 was higher for the aprocitentan group compared to placebo. The decrease in BP load during daytime/nighttime was also more pronounced with aprocitentan compared to placebo. Despite the BP lowering effect of aprocitentan, heart rate remained unchanged at week 36. The BP lowering effect of aprocitentan was not diminished by increased arterial stiffness index or salt sensitivity risk at baseline.

In addition to a significant and sustained day and night-time ambulatory BP reduction, aprocitentan was associated with a higher proportion of patients experiencing dipping pattern normalization and more pronounced BP load reduction, indicating prognostic relevance. Increased arterial stiffness or salt sensitivity did not alter the BP response to aprocitentan, suggesting additional clinical benefit.