A new approach to treating resistant hypertension

Many patients have resistant hypertension, which isuncontrolled byavailable drugs and behavioural interventions. Hence, new treatment approaches are needed. The endothelin pathway (an antihypertensive mechanism) is thought to contribute to hypertension, and currently no medications target this pathway. On the heels of positive preliminary evidence, investigators conducted an industry-supported, randomised, phase 3 trial of aprocitentan, an oral medication that blocks endothelin A and B receptors.

The primary endpoint was a 4-week change in unattended office systolic blood pressure (a systolic blood pressure equal to or above 140 mmHg and/or diastolic blood pressure equal to or above 90 mmHg). Despite taking three antihypertensive including a diuretic, participants had high systolic blood pressure above 140 mm Hg.

At 4 weeks, placebo lowered systolic blood pressure by 11.5 mm Hg. The intervention arms had greater declines than the placebo arm.. The main adverse effect was fluid retention.

This phase 3 trial shows that adding this medicine to a hefty regimen could reduce blood pressure further. This blood pressure drop is significant, but not game-changing. The authors claim that this would translate into a 10% relative reduction in risk; that claim would have to be validated in an outcomes trial.