Would a new drug option for resistant hypertension get you excited? How about a superior trial design?
Time to learn about PRECISION - our twitter journal club had 720 tweets, but you can catch the highlights quickly with the regular #TenTweetNephJC thread👇
Time to learn about PRECISION - our twitter journal club had 720 tweets, but you can catch the highlights quickly with the regular #TenTweetNephJC thread👇
2/10
What did I miss?
We know we miss targeting many pathways that contribute to resistant hypertension, a condition with high cardiovascular morbidity.
Enter aprocitentan, a dual endothelin receptor antagonist, for it’s crack at a Phase 3 trial.
pubmed.ncbi.nlm.nih.gov/36356632/
What did I miss?
We know we miss targeting many pathways that contribute to resistant hypertension, a condition with high cardiovascular morbidity.
Enter aprocitentan, a dual endothelin receptor antagonist, for it’s crack at a Phase 3 trial.
pubmed.ncbi.nlm.nih.gov/36356632/
3/10
1 tweet methods
✅ Multi-center, blinded, randomised, parallel-group
✅ Elaborate run-in (figure) to give all amlod + HCTZ + valsartan, and then exclude pseudoresistant hypertension
✅ Does adding aprocitentan to regime improve unattended automated office BP 🆚 placebo?
1 tweet methods
✅ Multi-center, blinded, randomised, parallel-group
✅ Elaborate run-in (figure) to give all amlod + HCTZ + valsartan, and then exclude pseudoresistant hypertension
✅ Does adding aprocitentan to regime improve unattended automated office BP 🆚 placebo?
4/10
1 tweet results
🔹730 patients randomised
🔹Mean age 62, 63% on ≥4 antihypertensives, baseline office BP 153/88
🔹At 4 weeks = reduction of 15.3mmHg systolic for aprocitentan, versus 11.5mmHg reduction with placebo
1 tweet results
🔹730 patients randomised
🔹Mean age 62, 63% on ≥4 antihypertensives, baseline office BP 153/88
🔹At 4 weeks = reduction of 15.3mmHg systolic for aprocitentan, versus 11.5mmHg reduction with placebo
5/10
A figure paints 1000 words
Also had proof of efficacy in ambulatory BP monitoring
A figure paints 1000 words
Also had proof of efficacy in ambulatory BP monitoring
6/10
Give me something clever to say
“The Achilles heel of endothelin receptor antagonists has been fluid retention & PRECISION followed suit, with uncomfortable rates of heart failure in the aprocitentan arm. Might co-prescription with a flozin mitigate these adverse events?”
Give me something clever to say
“The Achilles heel of endothelin receptor antagonists has been fluid retention & PRECISION followed suit, with uncomfortable rates of heart failure in the aprocitentan arm. Might co-prescription with a flozin mitigate these adverse events?”
7/10
Chat consensus?
1️⃣ Aprocitentan does work in resistant hypertension, proven by convincing trial design
2️⃣ uACR 30% reduction encouraging
3️⃣ BUT this was a trial against placebo, not spiro that we actually use 4th line, is cardioprotective, is inexpensive, is beloved
Chat consensus?
1️⃣ Aprocitentan does work in resistant hypertension, proven by convincing trial design
2️⃣ uACR 30% reduction encouraging
3️⃣ BUT this was a trial against placebo, not spiro that we actually use 4th line, is cardioprotective, is inexpensive, is beloved
8/10
Quote of the fortnight!
I think everyone agrees with @goupil_remi - an antihypertensive as good as doxazosin is worth limited celebration…
Quote of the fortnight!
I think everyone agrees with @goupil_remi - an antihypertensive as good as doxazosin is worth limited celebration…
https://twitter.com/goupil_remi/status/1600317498426998785?s=20&t=rs5uCeEznyPNREMVkenJzA
9/10
I want more info
✅ Is it reasonable to expect proof of end organ benefit in resistant hypertension trials? Enjoy working through the sums in this fantastic thread by @ProfDFrancis
✅ Summary @thana_susan
nephjc.com/news/aprociten…
✅ VA @Sandyrvsdav
I want more info
✅ Is it reasonable to expect proof of end organ benefit in resistant hypertension trials? Enjoy working through the sums in this fantastic thread by @ProfDFrancis
https://twitter.com/ProfDFrancis/status/1012197252687855616?s=20&t=MAfjnAP3lEywjbz45_MYyw
✅ Summary @thana_susan
nephjc.com/news/aprociten…
✅ VA @Sandyrvsdav
10/10
Final thoughts
✳️ For now, we’ll stick with spiro & flozins
➡️ Coming 20/21 Dec - Lancet again for MyTEMP, the largest ever trial in patients on haemodialysis, looking at CV outcomes with standard 🆚 cooled dialysate
pubmed.ncbi.nlm.nih.gov/36343653/
Tweetorial by @jamiekwillows
Final thoughts
✳️ For now, we’ll stick with spiro & flozins
➡️ Coming 20/21 Dec - Lancet again for MyTEMP, the largest ever trial in patients on haemodialysis, looking at CV outcomes with standard 🆚 cooled dialysate
pubmed.ncbi.nlm.nih.gov/36343653/
Tweetorial by @jamiekwillows
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