First Drug for Resistant Hypertension Approved

In March 2024, the FDA approved once-daily aprocitentan (brand name TRYVIO) for treating high blood pressure in adults who don’t respond well to other medications. About 10% of people with hypertension pressure cannot reach recommended levels even with existing treatments. Aprocitentan works by blocking endothelin, a substance that narrows blood vessels and raises blood pressure. The drug was tested in a large study called PRECISION involving adults with high blood pressure who were already taking at least three other medications for hypertension. Most of the study participants were white, male, and in their 60s. The main goal was to see how much aprocitentan lowered systolic (upper number) blood pressure. Though aprocitentan only lowered blood pressure by about 4 millimeters of mercury (mmHg) in trials, it’s considered safe for people with kidney disease, who often have limited treatment options. There are however several caveats: The drug has a black-box warning for embryo–fetal toxicity, so pregnant women should not take it, it is only available through a restricted program, and physicians and pharmacies need certification to prescribe and supply it. Also, the cost is currently unknown, but it could be expensive and cost-prohibitive for some people.

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