Vnitr Lek 2026, 72(6):E16-E20 | DOI: 10.36290/vnl.2026.079

Aprocitentan - a dual endothelin receptor antagonist for the treatment of resistant arterial hypertension

Jitka Mlíková Seidlerová

II. interní klinika LF a FN v Plzni

Aprocitentan is a dual endothelin receptor inhibitor and a new drug approved in both the U.S. and Europe for the treatment of resistant hypertension. It is distinctive in that it targets a pathophysiological mechanism that is not affected by any existing antihypertensive medications. Unlike first-generation endothelin receptor blockers, it is not metabolized by CYP450 or BcRP, which means a lower risk of drug interactions. Current evidence demonstrates a significant reduction in blood pressure, both clinical and 24-hour, including sustained reductions during the night. In the PRECISION study, the difference in blood pressure reduction in patients treated with aprocitentan at doses of 12.5 and 25 mg compared with placebo was -4.2 mm Hg (95% CI -6.2 to -2.1) and -5.9 mm Hg (-7.9 to 3.8) for 24-hour systolic blood pressure. However, long-term data on its safety are still lacking, and, above all, evidence of its effect on reducing cardiovascular complications is missing. The most common adverse effects are fluid retention, the development of edema, and the onset of mild anemia.

Keywords: aprocitentan, dual endothelin receptor inhibitor, arterial hypertension, resistant hypertension.

Accepted: September 16, 2026; Published: October 2, 2026  Show citation