Daijiworld Media Network – New Delhi

New Delhi, Feb 14: The way high blood pressure is treated could soon witness its biggest shift in decades, with long-acting injectable therapies promising control with just two doses a year instead of daily pills.

A recent review published in The Lancet highlights how these emerging treatments, now in late-stage clinical trials, could redefine hypertension care. Despite the availability of effective oral medicines for years, global blood pressure control remains poor, largely due to poor adherence, weak health systems and long-term treatment fatigue.

Hypertension remains the leading cause of heart attacks, strokes and premature deaths worldwide. The World Health Organization defines it as blood pressure at or above 140 mm Hg systolic and/or 90 mm Hg diastolic, while normal levels are below 120/80 mm Hg.

Globally, an estimated 1.4 billion adults aged 30 to 79 live with hypertension, with nearly 44 per cent unaware of their condition. Among those diagnosed, fewer than one in four have their blood pressure under control.

India mirrors the crisis. The Indian Council of Medical Research-INDIAB study in 2023 estimated that 315 million Indians, or 35.5 per cent of the population, have hypertension. Data from National Family Health Survey-5 showed that nearly half of hypertensive men and over a third of hypertensive women in the country do not have adequate control.

For decades, treatment has relied on combinations of daily oral drugs such as ACE inhibitors, angiotensin receptor blockers, calcium channel blockers and thiazide diuretics. While effective in theory, adherence remains a major challenge, especially as many patients also manage diabetes, obesity or cholesterol disorders requiring multiple medications.

New long-acting injectables aim to address this gap by targeting upstream molecular pathways that drive hypertension. One promising approach involves small interfering RNA agents that suppress angiotensinogen production in the liver, thereby dampening the renin–angiotensin system central to blood pressure regulation. Zilebesiran, developed by Roche Pharma and Alnylam, is currently in global phase 3 trials.

Another candidate, ziltivekimab by Novo Nordisk, targets inflammatory pathways linked to cardiovascular risk, aiming to reduce both blood pressure and broader vascular damage. Researchers are also exploring therapies that more precisely regulate aldosterone, a hormone that increases blood volume and pressure.

Experts say the appeal of twice-yearly injections lies in their durability and ability to ensure consistent drug exposure, potentially improving long-term control and reducing heart attacks and strokes.

However, caution remains. The high cost of injectable therapies could limit accessibility, particularly in low- and middle-income countries. The example of inclisiran, an injectable cholesterol-lowering drug introduced in India in 2024 at an annual cost of Rs 1.8 lakh to Rs 2.4 lakh, underscores affordability concerns.

Long-term safety is another key consideration, as hypertension requires lifelong management. Specialists stress that while early trial results are encouraging, robust long-term data across diverse populations will be essential before widespread adoption.

If proven safe, effective and affordable, twice-yearly injections could mark a decisive shift in preventive cardiology, easing the treatment burden for millions worldwide.