What does aprecitentan (Tryvio) treat? Indications and clinical applications

Aprocitentan-Tryvio is a newly developed endothelin A receptor antagonist, mainly used to treat refractory hypertension , patients who cannot control their blood pressure within the target range even after using at least three antihypertensive drugs (usually including diuretics). Such patients often suffer from multiple cardiovascular and metabolic diseases, such as obesity, diabetes, chronic kidney disease, etc. The structure and function of blood vessels have been significantly changed, and the effect of traditional antihypertensive treatment is limited. The launch of Tryvio brings new treatment options to such high-risk groups.

Tryvio's core mechanism of action is to block endothelin A receptors. Endothelin-1 (ET-1) is one of the most powerful vasoconstrictor substances in the human body, and it plays a key role in the development of hypertension. When endothelin-1 binds to its A receptor, it will trigger a series of pathological reactions such as vascular smooth muscle contraction, increased blood pressure, enhanced inflammatory response, and vascular remodeling. Tryvio can selectively antagonize this pathway, relieve vascular tension, thereby achieving a blood pressure lowering effect, and has the potential to delay the occurrence of cardiovascular complications.

In clinical applications,Tryvio is usually used as part of combination therapy. It will not replace conventional first-line antihypertensive drugs such as ACE inhibitors, ARBs, calcium channel blockers or diuretics, but it can be added as a fourth drug to the treatment plan when blood pressure is poorly controlled for a long time. Especially for patients with high 24-hour ambulatory blood pressure, large nighttime blood pressure fluctuations, and poor heart rate variability, Tryvio may provide additional clinical benefits.

It is worth noting that hypertension is not just a problem of rising numbers. Its long-term effects include arteriosclerosis, left ventricular hypertrophy, retinopathy, renal function decline, etc. Therefore, the goal of controlling blood pressure is not only to normalize the number, but also to reduce the risk. Tryvio’s targeting mechanism starts from vascular endothelial function, reflecting the future trend of precision treatment of hypertension.

Reference materials:https://go.drugbank.com/drugs/DB15059