Manickavasagar Revathy, Krishnan Anoushka, Azzam Omar, Schlaich Markus P
Department of Nephrology & Transplantation, Royal Perth Hospital, Perth, Australia.
Dobney Hypertension Centre, Medical School - Royal, Perth Hospital Unit and RPH Research Foundation, The University of Western Australia, Level 3, MRF Building, Rear 50 Murry St, Perth, WA, 6000, Australia.
Curr Cardiol Rep. 2025 Jul 2;27(1):106. doi: 10.1007/s11886-025-02262-3.
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.
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.
内皮素系统是高血压病理生理学中一个高度相关的组成部分，目前现有的治疗方法无法对其产生有效抑制作用。我们研究了双重内皮素受体拮抗剂在顽固性高血压治疗中的作用。
最近的PRECISION试验表明，使用双重内皮素受体拮抗剂阿曲生坦治疗顽固性高血压具有显著的降压效果。阿曲生坦在75岁以上患者、非裔美国患者以及糖尿病和晚期慢性肾脏病患者中显示出特别的疗效。蛋白尿也有所减少。阿曲生坦耐受性良好，通过密切的临床监测和利尿剂治疗的滴定可以减轻液体潴留的风险。阿曲生坦为顽固性高血压提供了一种新的治疗选择，在以往难以实现血压目标的患者群体中显示出特别的疗效。
