Treatment for high blood pressure, which has traditionally relied on daily medication, may soon shift to just two long-acting injections per year.
A recent review published in The Lancet highlights a new generation of therapies now in late-stage clinical trials that could fundamentally reshape hypertension care. This comes at a time when blood-pressure control rates remain worryingly low, despite decades of available drugs.
Hypertension is the leading cause of heart attacks, strokes and premature death worldwide. The World Health Organisation defines it as blood pressure of 140/90 mm Hg or higher, while normal levels are below 120/80 mm Hg.
One of the most advanced candidates is zilebesiran, being developed by Roche and Alnylam Pharmaceuticals. The drug works by suppressing the liver’s production of angiotensinogen, a key protein in blood-pressure regulation. It is currently in Phase 3 trials following encouraging mid-stage results.
Another investigational therapy, Ziltivekimab from Novo Nordisk, aims not only to lower blood pressure but also to reduce inflammation and damage within blood vessels.
Several of these treatments use small interfering RNA (siRNA) technology to block angiotensinogen synthesis, thereby disrupting the hormonal pathway that drives hypertension.
Experts say the major advantage of twice-yearly injections is their durability. By ensuring consistent drug levels over long periods, they could improve adherence, enhance blood-pressure control and reduce the risk of heart attacks and strokes.
However, cost remains a significant concern. The high price of injectable therapies could limit access, particularly in low- and middle-income countries.
Researchers caution that although early trial results are promising, robust long-term safety and effectiveness data across diverse populations will be essential before widespread adoption. Because hypertension requires lifelong treatment, safety is paramount.
If proven safe, effective and affordable, these therapies could mark a major shift in preventive cardiology and reduce the treatment burden for millions of patients.
Dr Amit Raj, director at Plexus Cardiac Care, said longer-term data could make twice-yearly dosing a practical reality and potentially lower the global burden of heart attacks and strokes linked to uncontrolled hypertension. He noted that injectable treatments may improve real-world control rates by eliminating missed daily doses, one of the biggest challenges in hypertension management.
Dr Dorairaj Prabhakaran, a cardiologist and executive director at a WHO collaborating centre for cardiovascular research, emphasised the need for careful evaluation of both short- and long-term safety of once- or twice-yearly injectable therapies for hypertension, as well as for related conditions such as obesity and lipid disorders.
Tribune
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