Endothelin receptor antagonists used for hypertension and kidney disease

A narrative review examines the clinical application of endothelin receptor antagonists (ERAs) for treating resistant hypertension, chronic kidney disease (CKD), and proteinuria.

Aprocitentan has become the first and only ERA approved specifically for hypertension. Clinical data from the PRECISION study indicated that a 12.5-mg once-daily dose reduced 24-hour ambulatory systolic blood pressure by 4.2 mm Hg compared to a placebo.

In cases of IgA nephropathy (IgAN), sparsentan has been shown to reduce proteinuria and slow the decline of the estimated glomerular filtration rate (eGFR). Additionally, atrasentan demonstrates antiproteinuric effects and a favorable eGFR slope.

Effective use of these agents requires careful patient selection and monitoring for potential side effects, including fluid retention, edema, anemia, liver-test abnormalities, and pregnancy risks. Clinicians are advised to optimize diuretic and cardiorenal therapies to manage volume expansion.