Post 4 weeks of withdrawal, office systolic blood pressure significantly increased with placebo versus aprocitentan by 5.8 mm Hg (95% CI 3.7-7.9; p<0.0001).
Systematic Review
Does aprocitentan reduce systolic blood pressure in patients with resistant hypertension?
Aprocitentan effectively reduces systolic blood pressure and is well tolerated in patients with resistant hypertension, with mild-to-moderate edema as the most common adverse effect.
Mean Difference: 5.8 (95% CI 3.7–7.9)
p-value: p=<0.0001
Objective: To generate comprehensive data on the efficacy, safety and tolerability of aprocitentan on patients with resistant hypertension and to note unmet needs or gaps through this systematic review. Design and method: This systematic review was registered with PROSPERO (CRD420261281689). We conducted this study using PRISMA checklist. Online databases including PubMed, Web of Science, Embase, Scopus, and google scholar were searched for relevant original articles on new drug aprocitentan. Words ‘efficacy’ ‘safety’ and ‘tolerabilty’ were looked for. Qualitative assessment is done after full text screening and data extraction. Results: We found 7 relevant researches related to drug aprocitentan and included them in our study. Aprocitentan is a noval oral dual endothelin A /endothelin B receptor antagonist with a long half-life of 44 hours. It was observed that from baseline to week 4 in patients with chronic kidney disease, aprocitentan 12.5 and 25 mg reduced mean sitting office systolic blood pressure by 13.5 and 16.6 mm Hg, respectively while placebo was 4.4 mm Hg, Changes in urine albumin-to-creatinine ratio were 47.1%, and 59.6%, compared to placebo 2.4%. In patients on beta blockers, 12.5 mg and 25 mg aprocitentan decreased systolic blood pressure from baseline to Week 4 by mean - 14.9 mmHg and -14.9 mmHg, respectively, vs 11.2 mmHg in the placebo group; and in patients without beta blockers by - 16.5 mmHg and - 14.9 mmHg vs - 11.8 mmHg. Post 4 weeks of withdrawal, office systolic blood pressure significantly increased with placebo versus aprocitentan (5·8 mm Hg, 95% CI 3·7 to 7·9, p<0·0001). Most common adverse effect was mild-to-moderate oedema or fluid retention, occurring in 9%, 18%, and 2% for patients receiving aprocitentan 12·5 mg, 25 mg, and placebo, respectively. The Pharrmacokinetics of aprocitentan were similar with moderate hepatic impairment patients and healthy subjects. Aprocitentan was well tolerated in subjects with severe renal function impairment. Conclusions: Aprocitentan has shown favourable outcomes in its efficacy compared to placebo. This medication is well tolerated with manageable adverse effects. Aprocitenatan is a valuable discovery in the management of resistant hypertension.
Tejaswi et al. (Fri,) conducted a systematic review in resistant hypertension. Aprocitentan vs. placebo was evaluated on office systolic blood pressure increase post 4 weeks of withdrawal (MD 5.8 mm Hg, 95% CI 3.7-7.9, p=<0.0001). Post 4 weeks of withdrawal, office systolic blood pressure significantly increased with placebo versus aprocitentan by 5.8 mm Hg (95% CI 3.7-7.9; p<0.0001).