High blood pressure affects huge numbers of people and is a major cause of heart attacks and strokes.
For many patients, controlling it means remembering to take one or more pills every day, sometimes for the rest of their lives.
That daily routine can be difficult to maintain. People may forget doses, stop treatment when they feel well, or struggle with side effects, leaving their blood pressure higher than it should be.
Researchers are therefore studying a very different approach: a long-lasting injection that may need to be given only twice a year. The experimental drug, called zilebesiran, is designed to lower blood pressure for months after a single injection.
An early clinical study involving researchers from the University of Edinburgh tested the treatment in 107 people with high blood pressure. Eighty participants received one injection of zilebesiran, while the others received a placebo with no active drug.
The results showed that a single injection could produce a substantial and long-lasting fall in systolic blood pressure, the top number in a blood pressure reading. This number measures the pressure in the arteries when the heart contracts and pumps blood.
People who received a 200-milligram dose had their systolic pressure fall by more than 10 mmHg. Those given an 800-milligram dose experienced a reduction of more than 20 mmHg.
These changes could be medically important because even a modest reduction in blood pressure can lower the risk of heart and blood vessel disease. The effect of zilebesiran also lasted for several months, raising the possibility of treatment with an injection about every six months.
Zilebesiran works differently from traditional blood pressure medicines. It targets the body’s renin-angiotensin system, which plays an important role in controlling blood pressure and the amount of salt and water in the body.
The drug acts mainly in the liver, where it reduces production of angiotensinogen. This is a substance the body uses to make hormones that can narrow blood vessels and raise blood pressure.
By reducing angiotensinogen at its source, zilebesiran may provide steady blood pressure control for a much longer period than a daily tablet. The drug was developed by the U.S. biotechnology company Alnylam Pharmaceuticals.
Professor David Webb of the University of Edinburgh said a long-lasting treatment could be particularly useful because many people have difficulty taking blood pressure medicine consistently. A twice-yearly injection could potentially remove much of that daily burden.
However, zilebesiran is still an experimental medicine. The early results do not yet show that it is safe and effective enough for routine use, and larger studies are needed to examine side effects and determine how well it works when combined with other blood pressure treatments.
Researchers also need to learn whether keeping blood pressure lower with this approach actually prevents heart attacks, strokes and other serious complications over many years. Those outcomes are ultimately more important than changes in blood pressure numbers alone.
High blood pressure often has no symptoms, so people may not realize that it is damaging their blood vessels, heart, brain and kidneys. Regular blood pressure checks and consistent treatment remain important even when a person feels completely healthy.
For now, people taking blood pressure medicine should continue following their doctor’s advice rather than changing treatment because of this research. But if future trials confirm the early findings, a shot given only once or twice a year could offer a much simpler way to keep high blood pressure under control.
The research on zilebesiran was published in the New England Journal of Medicine.
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