Aprocitentan: A New Option for Resistant Hypertension and Its Place in Patient Care

Hypertension affects approximately 47.7% of US adults, with higher rates observed in men (50.8%) compared with women (44.6%). Risk factors and characteristics such as age, family history, race, and ethnicity also can increase the risk of developing high blood pressure and can make treatment more difficult. Aprocitentan is the first dual endothelin receptor antagonist approved for the treatment of resistant hypertension. The PRECISION clinical trial resulted in a mean change in office systolic blood pressure at 4 weeks of -15.3 mm Hg for aprocitentan 12.5 mg, -15.2 mm Hg for aprocitentan 25 mg, and -11.5 mm Hg for placebo, for a difference versus placebo of -3.8 mm Hg (97.5% confidence interval -6.8 to -0.8, P=0.0042) and -3.7 (1.3) mm Hg (97.5% confidence interval -6.7 to -0.8, P=0.0046), respectively. Aprocitentan has shown benifit in further reduction of blood pressure for individuals who have failed standard triple therapy, such as a combination of an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker, nondihydropyridine calcium channel blocker, and thiazide or thiazide.