Clinical Strategies For Managing Resistant Hypertension: Emerging Tools and Therapeutic Insights - Episode 6
The PRECISION Trial
Panelists discuss how the PRECISION trial demonstrated aprocitentan’s efficacy in lowering blood pressure by nearly 15 mm Hg within 4 weeks in resistant hypertension patients, including those with advanced chronic kidney disease, with durable effects and minimal adverse effects except for manageable peripheral edema.
Video content above is prompted by the following:
The PRECISION trial established aprocitentan’s efficacy and safety in resistant hypertension through a comprehensive 3-phase study design involving patients with true treatment resistance on background ACD therapy. Phase 1 demonstrated significant blood pressure reduction of approximately 15 mm Hg systolic within 4 weeks using 12.5 mg daily aprocitentan compared to placebo in patients with office blood pressures above 140/90 mm Hg despite optimal background therapy.
The trial’s unique design included patients with advanced chronic kidney disease (glomular filtration rate [GFR] down to 15 mL/min/1.73m²), distinguishing it from previous resistant hypertension studies that typically excluded patients with significant renal impairment. This inclusion criteria reflects real-world resistant hypertension populations and demonstrates aprocitentan’s safety profile across the spectrum of kidney function, addressing a critical unmet need in high-risk patients where traditional fourth-line agents may be contraindicated.
Phase 2 evaluated long-term safety and durability over 38 weeks, while phase 3 confirmed sustained efficacy through withdrawal and rerandomization. The trial demonstrated consistent blood pressure lowering across all demographic subgroups including age, gender, race, baseline GFR, and comorbidities. Safety analysis revealed no adverse effects on kidney function or electrolyte balance, with peripheral edema as the primary tolerability concern, manageable with diuretic optimization and rarely requiring discontinuation.
