Aprocitentan in Practice: Real-World Insights from the Front Lines

Real-world clinical experience with aprocitentan demonstrates its effectiveness in patients with truly resistant hypertension who have failed multiple conventional therapies. Dr Cohen describes treating a patient already on 4 antihypertensive medications who experienced remarkable blood pressure improvement within 1 month of adding aprocitentan to her regimen. The patient achieved blood pressure readings that had not been seen with previous treatment combinations, demonstrating the medication’s ability to provide additional therapeutic benefit in heavily pretreated patients.

The side effect profile of aprocitentan appears manageable in clinical practice, with fluid retention being the most commonly observed adverse effect. Dr Cohen’s patient experienced mild ankle swelling that was successfully managed with as-needed diuretic dose adjustments rather than requiring medication discontinuation. This approach allows patients to continue benefiting from the blood pressure-lowering effects while managing predictable adverse effects through existing therapeutic relationships and medication adjustments.

One of the most valuable characteristics of aprocitentan in clinical practice is its ability to provide significant blood pressure reduction without causing excessive hypotension or overcorrection. Many advanced antihypertensive therapies risk causing blood pressure to drop too dramatically, leading to fatigue, kidney under-perfusion, and other complications. Dr Cohen appreciated that aprocitentan effectively “took the edge off” elevated blood pressures while maintaining stable, appropriate blood pressure ranges that didn’t compromise patient well-being or organ perfusion.