Endothelin Receptor Antagonists for the Treatment of Hypertension: Recent Data from Clinical Trials and Implementation Approach.

Purpose Of Review: The endothelin system is a highly relevant component of the pathophysiology of hypertension, which is currently unopposed by existing treatment approaches. We examined the role of dual endothelin receptor antagonists in the treatment of resistant hypertension.

Recent Findings: The recent PRECISION trial demonstrated significant blood pressure lowering effect with the use of the dual endothelin receptor antagonist aprocitentan in the treatment of resistant hypertension. Aprocitentan was shown to be particularly effective in patients over 75 years of age, African-American patients, and patients with diabetes and advanced CKD. There was also a decrease in proteinuria. Aprocitentan was well tolerated and the risk of fluid retention can be mitigated by close clinical monitoring and titration of diuretic therapy. Aprocitentan presents a novel treatment option for resistant hypertension, with particular efficacy noted in patient cohorts who have historically been challenging to achieve blood pressure targets in.