Two injections a year may transform hypertension care, says Lancet review

Long-acting medicines, including RNA-based therapies, may soon allow patients to manage high blood pressure with just two doses a year

For decades, managing high blood pressure has meant remembering a pill every morning and adjusting doses when readings fluctuate. However, a new review in The Lancet suggests that just two injections a year could offer long-lasting control and potentially transform how hypertension is treated.

 

Rethinking how high blood pressure is treated

 

The Lancet review titled ‘New drug therapies for hypertension’ brings together the latest evidence on emerging medicines and highlights innovations that go beyond traditional daily tablets. These treatments aim to target the underlying biology of high blood pressure rather than simply lowering the numbers, and some are designed to be taken infrequently while still maintaining steady control.

 

 

One of the medicines discussed is zilebesiran, an investigational therapy that uses small interfering RNA technology to block the production of angiotensinogen in the liver, which is a key component of the hormonal system that raises blood pressure. Early clinical data show that a single injection given under the skin can lower systolic blood pressure, pressure in your arteries when your heart beats and contracts, for up to six months. This means patients may only need two injections a year to keep their blood pressure under control.

 

The review also highlights other novel medicines in development that take different approaches:

 

• Ziltivekimab – a monoclonal antibody (laboratory-made protein designed to target a specific substance in the body) that targets inflammatory pathways linked to cardiovascular risk
• Selective aldosterone modulators – medications that inhibit the action of aldosterone, a hormone that regulates blood pressure by managing sodium and potassium levels

 

While these therapies are still being studied and are not yet widely approved, they share a focus on precision treatment that addresses the root causes of hypertension. Together, they signal a more advanced and targeted era in blood pressure care.

 

What this means for people with hypertension

 

For many patients, daily medication is a struggle. Pills can be forgotten, side effects can discourage continued use, and treatment burnout is common, especially among those juggling multiple conditions such as diabetes or high cholesterol. Long-acting injections could ease this burden and ensure more consistent blood pressure control because a twice-yearly injection removes the need for daily adherence and may lead to fewer missed doses.

 

Here are the key potential advantages of this approach:

 

• Reduced pill burden, which can improve long-term adherence
• Stable blood pressure levels over months rather than hours or days
• Simplified treatment regimens, especially for older adults and people with multiple health issues.
• Potential to decrease cardiovascular events if sustained control translates to fewer heart attacks and strokes

 

What experts say

 

Cardiologists and researchers are cautiously enthusiastic about these advances. Many point out that poor adherence to daily medication is one of the biggest barriers to effective blood pressure control and that long-acting therapies could help bridge this gap. Some believe that twice-yearly injections may one day become a practical reality for many patients if large-scale trials confirm ongoing safety and cardiovascular benefits.

 

However, other clinicians stress that this is early science and caution that safety in large and diverse populations must be fully understood before these treatments can replace or supplement current standard care. Cost and access are additional concerns, because biotechnological therapies often enter the market at high price points, potentially limiting their reach in low- and middle-income countries where hypertension is highly prevalent.   

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This report is for informational purposes only and is not a substitute for professional medical advice.