Aprocitentan Reduces BP in Black Patients

The publication reports preplanned analyses of the efficacy, tolerability and safety of aprocitentan – Idorsia’s once-daily, orally active, dual endothelin receptor antagonist – in the subgroup of black  American patients enrolled in the Phase III PRECISION study in patients with confirmed resistant hypertension. Aprocitentan, when added to a combination of at least three antihypertensive drugs (four in more than 50% of patients), produced clinically meaningful and sustained blood pressure reductions. Aprocitentan also markedly decreased proteinuria in the patients with proteinuria at baseline. As reported by the authors, aprocitentan was safe and well tolerated, even in those Black patients with chronic kidney disease.

The publication is accompanied by an Editorial entitled “Endothelin Antagonism: A New Era for Resistant Hypertension? from Gavin B. Chapman and Neeraj Dhaun of Edinburgh Kidney, University/BHF Centre for Cardiovascular Science, The Queen’s Medical Research Institute, University of Edinburgh, United Kingdom and Department of Renal Medicine, Royal Infirmary of Edinburgh, UK

Prof. Keith C. Ferdinand,  Tulane University School of Medicine, Tulane Heart & Vascular Institute, US, co-author of the publication and investigator in the PRECISION study, commented: “Black individuals frequently present with resistant hypertension and disproportionately increased cardiovascular risk. This is possibly related to the activated endothelin system seen in patients prone to developing resistant hypertension and this may explain why existing therapies that do not target the endothelin system have not shown optimal improvement for Black patients. Now, for the first time, we have an approved treatment targeting the endothelin system that may help fulfil an unmet need in Black patients with resistant hypertension.”

Prof. John M. Flack, Sergio Rabinovich Endowed Chair of Internal Medicine, Chairman Departments of Medicine and Population Science and Policy, Southern Illinois University School of Medicine, Lead author of the publication and investigator in the PRECISION study, commented: “The salt-sensitive, low-renin, hypertension often seen in Black patients makes their hypertension difficult to control and increases their cardiovascular risk. In fact, Black adults with hypertension less often achieve the guideline recommended BP goals, leading to an estimated 400,000 strokes, heart attacks and other cardiovascular events that could be prevented over 10 years if blood pressure control could be achieved. In PRECISION, the effect of aprocitentan for these patients was striking and I agree with the Editorial in suggesting that we are entering a new “era” for resistant hypertension, as with aprocitentan, the dual endothelin receptor antagonist or “ERA”, we can now tackle this important pathway.”

See citation- Flack JM, et al. Aprocitentan for Blood Pressure Reduction in Black Patients. Hypertension. 2025;82: 601.