TY - JOUR
T1 - Dual endothelin antagonist aprocitentan for resistant hypertension (PRECISION): a multicentre, blinded, randomised, parallel-group, phase 3 trial
AU - Schlaich, Markus
AU - Bellet, Marc
AU - Weber, Michael A
AU - Danaietash, Parisa
AU - Bakris, George L
AU - Flack, John M
AU - Dreier, Roland F
AU - Sassi-Sayadi, Mouna
AU - Haskell, Lloyd P
AU - Narkiewicz, Krzysztof
AU - Wang, Ji-Guang
AU - Reid, Christopher
AU - Schlaich, Markus
AU - Katz, Ivor
AU - Ajani, Andrew
AU - Biswas, Sinjini
AU - Esler, Murray
AU - Elder, Grahame
AU - Roger, Simon
AU - Colquhoun, David
AU - Mooney, John
AU - De Backer, Tine
AU - Persu, Alexandre
AU - Chaumont, Martin
AU - Krzesinski, Jean-Marie
AU - Vanabsche, Thomas
AU - Girard, Ginette
AU - Pliamm, Lew
AU - Schiffrin, Ernesto
AU - Merali, Fatima
AU - Dresser, George
AU - Vallee, Michel
AU - Jolly, Shivinder
AU - Chow, Stephen
AU - Wang, Jiguang
AU - Mu, Jianjun
AU - Yu, Jing
AU - Yuan, Hong
AU - Feng, Yingqing
AU - Zhang, Xin
AU - Xie, Jianhong
AU - Lin, Ling
AU - Soucek, Miroslav
AU - Widimsky, Jiri
AU - Cifkova, Renata
AU - Vaclavik, Jan
AU - Ullrych, Martin
AU - MacLeod, Mary
AU - McLay, James
AU - Calhoun, David
AU - PRECISION investigators
AU - Macleod, Mary
N1 - Acknowledgments
The study was supported by Idorsia Pharmaceuticals and Janssen Biotech. We thank the patients for their participation, and all the nursing teams and PRECISION investigators for their involvement in patient care and contribution to the study. Sylvie I Ertel (Sundgau Medical Writers, Habsheim, France) provided medical writing support, which was funded by Idorsia Pharmaceuticals and Janssen Biotech.
PY - 2022/12/9
Y1 - 2022/12/9
N2 - Summary Background Resistant hypertension is associated with increased cardiovascular risk. The endothelin pathway has been implicated in the pathogenesis of hypertension, but it is currently not targeted therapeutically, thereby leaving this relevant pathophysiological pathway unopposed with currently available drugs. The aim of the study was to assess the blood pressure lowering efficacy of the dual endothelin antagonist aprocitentan in patients with resistant hypertension. Methods PRECISION was a multicentre, blinded, randomised, parallel-group, phase 3 study, which was done in hospitals or research centres in Europe, North America, Asia, and Australia. Patients were eligible for randomisation if their sitting systolic blood pressure was 140 mm Hg or higher despite taking standardised background therapy consisting of three antihypertensive drugs, including a diuretic. The study consisted of three sequential parts: part 1 was the 4-week double-blind, randomised, and placebo-controlled part, in which patients received aprocitentan 12·5 mg, aprocitentan 25 mg, or placebo in a 1:1:1 ratio; part 2 was a 32-week single (patient)-blind part, in which all patients received aprocitentan 25 mg; and part 3 was a 12-week double-blind, randomised, and placebo-controlled withdrawal part, in which patients were re-randomised to aprocitentan 25 mg or placebo in a 1:1 ratio. The primary and key secondary endpoints were changes in unattended office systolic blood pressure from baseline to week 4 and from withdrawal baseline to week 40, respectively. Secondary endpoints included 24-h ambulatory blood pressure changes. The study is registered on ClinicalTrials.gov, NCT03541174. Findings The PRECISION study was done from June 18, 2018, to April 25, 2022. 1965 individuals were screened and 730 were randomly assigned. Of these 730 patients, 704 (96%) completed part 1 of the study; of these, 613 (87%) completed part 2 and, of these, 577 (94%) completed part 3 of the study. The least square mean (SE) change in office systolic blood pressure at 4 weeks was –15·3 (SE 0·9) mm Hg for aprocitentan 12·5 mg, –15·2 (0·9) mm Hg for aprocitentan 25 mg, and –11·5 (0·9) mm Hg for placebo, for a difference versus placebo of –3·8 (1·3) mm Hg (97·5% CI –6·8 to –0·8, p=0·0042) and –3·7 (1·3) mm Hg (–6·7 to –0·8; p=0·0046), respectively. The respective difference for 24 h ambulatory systolic blood pressure was –4·2 mm Hg (95% CI –6·2 to –2·1) and –5·9 mm Hg (–7·9 to –3·8). After 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
AB - Summary Background Resistant hypertension is associated with increased cardiovascular risk. The endothelin pathway has been implicated in the pathogenesis of hypertension, but it is currently not targeted therapeutically, thereby leaving this relevant pathophysiological pathway unopposed with currently available drugs. The aim of the study was to assess the blood pressure lowering efficacy of the dual endothelin antagonist aprocitentan in patients with resistant hypertension. Methods PRECISION was a multicentre, blinded, randomised, parallel-group, phase 3 study, which was done in hospitals or research centres in Europe, North America, Asia, and Australia. Patients were eligible for randomisation if their sitting systolic blood pressure was 140 mm Hg or higher despite taking standardised background therapy consisting of three antihypertensive drugs, including a diuretic. The study consisted of three sequential parts: part 1 was the 4-week double-blind, randomised, and placebo-controlled part, in which patients received aprocitentan 12·5 mg, aprocitentan 25 mg, or placebo in a 1:1:1 ratio; part 2 was a 32-week single (patient)-blind part, in which all patients received aprocitentan 25 mg; and part 3 was a 12-week double-blind, randomised, and placebo-controlled withdrawal part, in which patients were re-randomised to aprocitentan 25 mg or placebo in a 1:1 ratio. The primary and key secondary endpoints were changes in unattended office systolic blood pressure from baseline to week 4 and from withdrawal baseline to week 40, respectively. Secondary endpoints included 24-h ambulatory blood pressure changes. The study is registered on ClinicalTrials.gov, NCT03541174. Findings The PRECISION study was done from June 18, 2018, to April 25, 2022. 1965 individuals were screened and 730 were randomly assigned. Of these 730 patients, 704 (96%) completed part 1 of the study; of these, 613 (87%) completed part 2 and, of these, 577 (94%) completed part 3 of the study. The least square mean (SE) change in office systolic blood pressure at 4 weeks was –15·3 (SE 0·9) mm Hg for aprocitentan 12·5 mg, –15·2 (0·9) mm Hg for aprocitentan 25 mg, and –11·5 (0·9) mm Hg for placebo, for a difference versus placebo of –3·8 (1·3) mm Hg (97·5% CI –6·8 to –0·8, p=0·0042) and –3·7 (1·3) mm Hg (–6·7 to –0·8; p=0·0046), respectively. The respective difference for 24 h ambulatory systolic blood pressure was –4·2 mm Hg (95% CI –6·2 to –2·1) and –5·9 mm Hg (–7·9 to –3·8). After 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
U2 - 10.1016/S0140-6736
DO - 10.1016/S0140-6736
M3 - Article
SN - 0140-6736
VL - 400
SP - 1927
EP - 1937
JO - The Lancet
JF - The Lancet
IS - 10367
ER -