Aprocitentan in resistant hypertension: PRECISION - Prof. Markus Schlaich, Prof. Patrick Rossignol

Prof. Dr. Markus Schlaich (Perth, Australia) and Prof. Dr. Patrick Rossignol (Monaco) discuss the role of endothelin antagonists in treatment of arterial hypertension, focussing upon the PRECISION study on the dual endothelin antagonist aprocitentan for therapy of resistant hypertension. Prof. Markus Schlaich is nephrologist, hypertension specialist and chair of the Dobney Hypertension Centre, which is a collaborative venture between The University of Western Australia and Royal Perth Hospital. Additionally, he is President of Hypertension Australia and President-Elect of the World Hypertension League (WHL). Prof. Patrick Rossignol is nephrologist, vascular medicine specialist and expert in hypertension. He is head of the Medical Specialties Service (Nephrology–Haemodialysis) at Princess Grace Hospital (CHPG) and Medical Director of the Monaco Private Haemodialysis Centre (CHPM). The interview was recorded on March 6th, 2026. Moderators: Prof. Dr. Dominique Guerrot (Rouen, France), Carolin Schneppe, Prof. Dr. Gunnar Heine (both Frankfurt am Main, Germany) Articles discussed: Dual endothelin antagonist aprocitentan for resistant hypertension (PRECISION): a multicentre, blinded, randomised, parallel-group, phase 3 trial. Schlaich MP, Bellet M, Weber MA, Danaietash P, Bakris GL, Flack JM, Dreier RF, Sassi-Sayadi M, Haskell LP, Narkiewicz K, Wang JG; PRECISION investigators Lancet 2022 doi: 10.1016/S0140-6736(22)02034-7 Aprocitentan in Patients With Chronic Kidney Disease and Resistant Hypertension Rossignol P, Clozel M, Dreier RF, Flack JM, Flamion B, Mann J, Narkiewicz K, Sassi-Sayadi M, Wang JG, Weber MA, Schlaich MP Hypertension 2026 doi: 10.1161/HYPERTENSIONAHA.125.25563 2024 ESC Guidelines for the management of elevated blood pressure and hypertension. McEvoy JW, McCarthy CP, Bruno RM, Brouwers S, Canavan MD, Ceconi C, Christodorescu RM, Daskalopoulou SS, Ferro CJ, Gerdts E, Hanssen H, Harris J, Lauder L, McManus RJ, Molloy GJ, Rahimi K, Regitz-Zagrosek V, Rossi GP, Sandset EC, Scheenaerts B, Staessen JA, Uchmanowicz I, Volterrani M, Touyz RM; ESC Scientific Document Group Eur Heart J 2024 doi: 10.1093/eurheartj/ehae178 Endocrine and haemodynamic changes in resistant hypertension, and blood pressure responses to spironolactone or amiloride: the PATHWAY-2 mechanisms substudies Williams B, MacDonald TM, Morant SV, Webb DJ, Sever P, McInnes GT, Ford I, Cruickshank JK, Caulfield MJ, Padmanabhan S, Mackenzie IS, Salsbury J, Brown MJ; British Hypertension Society programme of Prevention And Treatment of Hypertension With Algorithm based Therapy (PATHWAY) Study Group. Lancet Diabetes Endocrinol 2018 doi: 10.1016/S2213-8587(18)30071-8 Resistant Hypertension Is Not Essential: It Is Primarily Aldosteronism. Brown MJ, Drake WM Hypertension 2026 doi: 10.1161/HYPERTENSIONAHA.125.26401 Spironolactone versus placebo, bisoprolol, and doxazosin to determine the optimal treatment for drug-resistant hypertension (PATHWAY-2): a randomised, double-blind, crossover trial Williams B, MacDonald TM, Morant S, Webb DJ, Sever P, McInnes G, Ford I, Cruickshank JK, Caulfield MJ, Salsbury J, Mackenzie I, Padmanabhan S, Brown MJ; British Hypertension Society's PATHWAY Studies Group Lancet 2015 doi: 10.1016/S0140-6736(15)00257-3 Reduction of Antihypertensive Treatment in Nursing Home Residents. Benetos A, Gautier S, Freminet A, Metz A, Labat C, Georgiopoulos I, Bertin-Hugault F, Beuscart JB, Hanon O, Karcher P, Manckoundia P, Novella JL, Diallo A, Vicaut E, Rossignol P; RETREAT-FRAIL Study Group. N Engl J Med 2025 doi: 10.1056/NEJMoa2508157 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension: Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA). Mancia G et al. J Hypertens 2023 doi: 10.1097/HJH.0000000000003480 Endothelin receptor antagonists in chronic kidney disease Smeijer JD, Kohan DE, Dhaun N, Noronha IL, Liew A, Heerspink HJL Nat Rev Nephrol 2025 doi: 10.1038/s41581-024-00908-z