顽固性高血压的新试验:喜忧参半的故事

NDT Plus Pub Date : 2023-09-27 DOI:10.1093/ckj/sfad251
Carmine Zoccali, Francesca Mallamaci, Luca De Nicola, Roberto Minutolo
{"title":"顽固性高血压的新试验:喜忧参半的故事","authors":"Carmine Zoccali, Francesca Mallamaci, Luca De Nicola, Roberto Minutolo","doi":"10.1093/ckj/sfad251","DOIUrl":null,"url":null,"abstract":"ABSTRACT Resistant hypertension (RH) is linked to an increased risk of cardiovascular and renal complications. Treatment options include non-pharmacological interventions, such as lifestyle modifications, and the use of specific antihypertensive drug combinations, including diuretics. Renal denervation is another option for treatment-resistant hypertension. New compounds targeting different pathways involved in RH—including inhibitors of aminopeptidase A, endothelin antagonists and selective aldosterone synthase inhibitors—have been tested in clinical trials in this condition. The centrally acting drug firibastat, targeting the brain renin–angiotensin system, failed to demonstrate significant effectiveness in reducing blood pressure (BP) in patients with difficult-to-treat and RH in the Firibistat in Resistant Hypertension (FRESH) trial. Aprocitentan, a dual endothelin A and B receptor antagonist, showed a moderate but statistically significant decrease in BP in patients with RH in the Parallel-Group, Phase 3 Study with Aprocitentan in Subjects with Resistant Hypertension (PRECISION) trial. However, concerns remain about potential adverse events, such as fluid retention. The use of baxdrostat, a selective aldosterone synthase inhibitor, showed promising results in reducing BP in patients with treatment-resistant hypertension in the Baxdrostat in Resistant Hypertension (BrigHTN) trial. However, a subsequent trial, HALO, failed to meet its primary endpoint. The unexpected results may be influenced by factors such as patient adherence and white-coat hypertension. Despite the disappointing results from HALO, the potential benefits of inhibiting aldosterone synthesis remain to be fully understood. In conclusion, managing RH remains challenging, and new compounds like firibastat, aprocitentan and baxdrostat have shown varied effectiveness. Further research is needed to improve our understanding and treatment of this condition.","PeriodicalId":18987,"journal":{"name":"NDT Plus","volume":"39 1","pages":"0"},"PeriodicalIF":0.0000,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"New trials in resistant hypertension: mixed blessing stories\",\"authors\":\"Carmine Zoccali, Francesca Mallamaci, Luca De Nicola, Roberto Minutolo\",\"doi\":\"10.1093/ckj/sfad251\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"ABSTRACT Resistant hypertension (RH) is linked to an increased risk of cardiovascular and renal complications. Treatment options include non-pharmacological interventions, such as lifestyle modifications, and the use of specific antihypertensive drug combinations, including diuretics. Renal denervation is another option for treatment-resistant hypertension. New compounds targeting different pathways involved in RH—including inhibitors of aminopeptidase A, endothelin antagonists and selective aldosterone synthase inhibitors—have been tested in clinical trials in this condition. The centrally acting drug firibastat, targeting the brain renin–angiotensin system, failed to demonstrate significant effectiveness in reducing blood pressure (BP) in patients with difficult-to-treat and RH in the Firibistat in Resistant Hypertension (FRESH) trial. Aprocitentan, a dual endothelin A and B receptor antagonist, showed a moderate but statistically significant decrease in BP in patients with RH in the Parallel-Group, Phase 3 Study with Aprocitentan in Subjects with Resistant Hypertension (PRECISION) trial. However, concerns remain about potential adverse events, such as fluid retention. The use of baxdrostat, a selective aldosterone synthase inhibitor, showed promising results in reducing BP in patients with treatment-resistant hypertension in the Baxdrostat in Resistant Hypertension (BrigHTN) trial. However, a subsequent trial, HALO, failed to meet its primary endpoint. The unexpected results may be influenced by factors such as patient adherence and white-coat hypertension. Despite the disappointing results from HALO, the potential benefits of inhibiting aldosterone synthesis remain to be fully understood. In conclusion, managing RH remains challenging, and new compounds like firibastat, aprocitentan and baxdrostat have shown varied effectiveness. Further research is needed to improve our understanding and treatment of this condition.\",\"PeriodicalId\":18987,\"journal\":{\"name\":\"NDT Plus\",\"volume\":\"39 1\",\"pages\":\"0\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2023-09-27\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"NDT Plus\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1093/ckj/sfad251\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"NDT Plus","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1093/ckj/sfad251","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

摘要

顽固性高血压(RH)与心血管和肾脏并发症的风险增加有关。治疗方案包括非药物干预,如改变生活方式,以及使用特定的抗高血压药物组合,包括利尿剂。肾去神经是治疗难治性高血压的另一种选择。针对rh参与的不同途径的新化合物,包括氨肽酶A抑制剂、内皮素拮抗剂和选择性醛固酮合成酶抑制剂,已经在这种情况下的临床试验中进行了测试。在非利巴斯他治疗顽固性高血压(FRESH)的试验中,靶向脑肾素-血管紧张素系统的中枢作用药物非利巴斯他在降低难治性RH患者血压(BP)方面未能显示出显著的有效性。阿procitentan是一种双重内皮素a和B受体拮抗剂,在阿procitentan在顽固性高血压患者中的平行组3期研究(PRECISION)中显示,RH患者的血压有中度但有统计学意义的降低。然而,人们仍然担心潜在的不良事件,如液体潴留。巴司他是一种选择性醛固酮合成酶抑制剂,在巴司他治疗顽固性高血压(BrigHTN)试验中,在降低顽固性高血压患者的血压方面显示出有希望的结果。然而,随后的一项试验HALO未能达到其主要终点。出乎意料的结果可能受到患者依从性和白大褂高血压等因素的影响。尽管HALO的结果令人失望,但抑制醛固酮合成的潜在益处仍有待充分了解。总之,RH的管理仍然具有挑战性,像非利巴斯他、阿普昔坦和巴司他这样的新化合物已经显示出不同的效果。需要进一步的研究来提高我们对这种情况的理解和治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
New trials in resistant hypertension: mixed blessing stories
ABSTRACT Resistant hypertension (RH) is linked to an increased risk of cardiovascular and renal complications. Treatment options include non-pharmacological interventions, such as lifestyle modifications, and the use of specific antihypertensive drug combinations, including diuretics. Renal denervation is another option for treatment-resistant hypertension. New compounds targeting different pathways involved in RH—including inhibitors of aminopeptidase A, endothelin antagonists and selective aldosterone synthase inhibitors—have been tested in clinical trials in this condition. The centrally acting drug firibastat, targeting the brain renin–angiotensin system, failed to demonstrate significant effectiveness in reducing blood pressure (BP) in patients with difficult-to-treat and RH in the Firibistat in Resistant Hypertension (FRESH) trial. Aprocitentan, a dual endothelin A and B receptor antagonist, showed a moderate but statistically significant decrease in BP in patients with RH in the Parallel-Group, Phase 3 Study with Aprocitentan in Subjects with Resistant Hypertension (PRECISION) trial. However, concerns remain about potential adverse events, such as fluid retention. The use of baxdrostat, a selective aldosterone synthase inhibitor, showed promising results in reducing BP in patients with treatment-resistant hypertension in the Baxdrostat in Resistant Hypertension (BrigHTN) trial. However, a subsequent trial, HALO, failed to meet its primary endpoint. The unexpected results may be influenced by factors such as patient adherence and white-coat hypertension. Despite the disappointing results from HALO, the potential benefits of inhibiting aldosterone synthesis remain to be fully understood. In conclusion, managing RH remains challenging, and new compounds like firibastat, aprocitentan and baxdrostat have shown varied effectiveness. Further research is needed to improve our understanding and treatment of this condition.
求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
自引率
0.00%
发文量
0
期刊最新文献
Sleep apnea syndrome prevalence in chronic kidney disease and end stage kidney disease patients: a systematic review and meta-analysis Mechanisms and treatment of Obesity-Related Hypertension: Part 1. Mechanisms Twenty years of the French Renal Epidemiology and Information Network Replacing a kidney biopsy by exome sequencing in undetermined kidney diseases – not yet ready for prime time! Kidney and urine cell transcriptomics in IgA nephropathy and lupus nephritis: a narrative review
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1