Endothelin antagonists and resistant hypertension in chronic kidney disease

Purpose of review Endothelin is a potent vasoconstrictor and promoter of renal disease. This review discusses recent developments in the use of endothelin receptor antagonists in resistant hypertension and chronic kidney disease. Recent findings Endothelin is a potent vasoconstrictor and growth factor. Endothelin production has been shown to be associated with renal disease including hypertension, chronic kidney disease, and proteinuria. Selective endothelin A receptor antagonists have been examined in clinical trials for the treatment of hypertension and proteinuric kidney disease, and appear to be effective in reducing blood pressure and improving proteinuria. However, their use is tempered by a significant side effect profile including an increase in total body sodium, which will likely limit their use to the treatment of resistant hypertension. Summary Selective endothelin antagonists are exciting new agents that could expand our antihypertensive arsenal and increase our efficacy in chronic kidney disease therapy. Specifically, they may represent a new approach in the treatment of resistant hypertension; however, their use is currently limited by significant sodium retention.