Abstract: TH-PO0323
Which Veterans Cannot Resist Aprocitentan?
Session Information
- Hypertension and CVD: Clinical - 1
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1602 Hypertension and CVD: Clinical
Authors
- Locastro, Marissa, UW Health, Madison, Wisconsin, United States
- Maursetter, Laura J., UW Health, Madison, Wisconsin, United States
- Gerber, Davina, UW Health, Madison, Wisconsin, United States
- Jimenez, Joseph, UW Health, Madison, Wisconsin, United States
- Meyer, Jodi, VA Medical Center Madison, Madison, Wisconsin, United States
- Dopp, John M., UW Health, Madison, Wisconsin, United States
Background
Hypertension, which is 23% more prevalent in the veteran population, remains a leading cause of chronic kidney disease (CKD). Aprocitentan, a dual endothelin receptor antagonist was recently approved for treatment of resistant hypertension in patients taking background triple medication antihypertensive therapy (PRECISION Trial). We sought to identify the percentage of eligible veterans with hypertension who could receive aprocitentan using eligibility criteria adapted from the PRECISION Trial (Table 1).
Methods
We conducted a retrospective, single-center study of all veterans cared for in the renal hypertension clinic at the William S. Middleton Memorial Veterans’ Hospital over an 18-month period (September 2023-March 2025). Data was extracted from the Computerized Patient Record System (CPRS). Descriptive statistics were used to report the percentage of veterans eligible for aprocitentan based on home and clinic blood pressure (BP) readings.
Results
There were 105 veterans included whose hypertension was being actively managed. Mean age was 73 [standard deviation (SD) 8.3]. Majority were men (93%) and White, non-Hispanic (86%). The mean estimated GFR and serum creatinine was 49.1mL/min/1.73m2 and 1.66 mg/dL, respectively. The most common comorbidity was type II diabetes (55%), followed by coronary artery disease (39%), heart failure (20%), and atrial fibrillation (19%). Six veterans were excluded for having unstable cardiovascular disease or because they had a stroke, transient ischemic attack, or acute coronary syndrome in the last 6 months.
34% and 29% of veterans were eligible for aprocitentan based on home and clinic BP readings, respectively. The three most common reasons excluding veterans from receiving aprocitentan include: 1) Home SBP < 130 (32%) or Clinic SBP < 140 (47%), 2) Veteran was on < 3 anti-hypertensive medications (24%), and 3) Diagnosis of heart failure (20%).
Conclusion
Approximately one-third of veterans in a renal hypertension clinic could be prescribed aprocitentan based on modified criteria from the PRECISION trial. Aprocitentan is currently non-formulary at the VA, but these data suggest a significant proportion of veterans with hypertension would be candidates to have it prescribed.
Eligibility criteria for Aprocitentan
| Inclusion Criteria | Exclusion Criteria |
| - Uncontrolled BP defined as either: Home blood pressure ≥130/80 or Clinic blood pressure ≥140/90 - Currently taking ≥3 anti-hypertensive medications - Secondary causes of uncontrolled BP ruled out - No adherence concerns | - Stroke/TIA/ACS in the last 6 months - Clinically significant unstable cardiac disease or heart failures - Uncontrolled arrhythmia or atrial fibrillation, CHF NYHA stage II with valve insufficiency or stenosis, CHF NYHA stage III-IV - ALT or AST > 3 times the upper limit of normal - BNP > 200 pg/mL - Treatment with any other endothelin antagonist - Known hypersensitivity to Aprocitentan |