Episode 271: 270. Aprocitentan, How Well Does it Work for Resistant Hypertension?

730 Patients were randomized to receive daily oral aprocitentan or placebo, plus a fixed-dose combination of amlodipine, valsartan, and hydrochlorothiazide.
After 4 weeks, mean change in office systolic BP was 15 mm Hg with aprocitentan and 11 mm Hg with placebo; this 4 mm difference was statistically significant.
What is the cost? What is the long term effects? Why didn't they compare this to the standard of care spironolactone?

https://www.hcplive.com/view/fda-approves-aprocitentan-tryvio-for-treatment-resistant-hypertension

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)02034-7/abstract