Currently, tackling high blood pressure requires a daily intake of 2-3 medications. But this may all change soon. Two revolutionary blood pressure drugs are currently in development that aim to lower blood pressure with a long lasting effect. One of the drugs is to be injected weekly, the other once in six months.
Hypertension sufferers take pills daily, because the current blood pressure lowering medications are short-acting. That is why we need to take them at least once a day. However, adherence rates are notoriously low. About one in two people prescribed blood pressure lowering medications stop taking them in the first year.
The new blood pressure drugs
The recent clinical trials have demonstrated that injectable treatments have reduced blood pressure for up to six months. These injectables could help achieve a long-lasting reduction in blood pressure. When these drugs receive regulatory approval, these injectables will be the first new drug class for high blood pressure.
Two promising drugs in clinical trials are IONIS-AGT-LRx by Ionis Pharmaceuticals and Zilebesiran by Alnylam Pharmaceuticals.
IONIS-AGT-LRx is to be injected under the skin weekly. It was tested up to February 2024 on very small trials. Larger trials are needed to confirm blood pressure lowering benefits and to progress with the development.
Zilebesiran is to be injected under the skin every six months. Studies in recent months show a significant and long lasting blood pressure lowering effect.
Zilebesiran’s blood pressure lowering effect is similar to a one type of blood pressure tablet (about a 10–15 mmHg reduction). Most people would need to use it with another blood pressure lowering pill.
How the new blood pressure drugs work
The work mechanism of both drugs is similar to already approved injectables, such as the diabetes and weight-loss drugs Ozempic. The main difference for a patient is that the two blood pressure lowering drugs will have to be injected by a doctor or nurse under the skin. They are not self administered as Ozempic.
The two drugs target a liver protein called angiotensinogen. It regulates blood pressure and fluid balance.
The injectables work by a process called RNA interference, which interferes with synthesis of the angiotensinogen protein. This disrupts the cascade of events that would otherwise lead to high blood pressure.
There is a class of currently used blood pressure pills called angiotensinogen inhibitors, but they work only for 24 hours.
Safety and side effects
The clinical studies show good tolerance in younger and middle-aged people with limited other health problems. The most common side effects are redness or swelling at the injection site in about one in six people.
A small proportion of people had mildly raised blood potassium levels and mild changes in kidney function, but this seemed to be short term. Such changes were observed with other classes of high blood pressure treatments.
Where are we now
Both injectables are not available to the public currently. Clinical trials are under way around the world to provide more evidence about their safety, interactions with other drugs, and ability to reduce rates of heart disease and stroke.
Zilebesiran is currently tested at multiple sites including Sydney’s Concord Repatriation General Hospital.
If large-scale trials are successful, the drug companies would then need to apply for regulatory approval. So it would likely be at least five years before these drugs were on the market.
If approved, initially at least these are likely to be prescribed for people at high risk or whose blood pressure is not adequately controlled by tablets.
Currently, the most effective way to control high blood pressure is a daily intake of medical drugs prescribed by your doctor and a healthy lifestyle. You can use the Heartery app to apply the latest achievements in digital health, to ease the medical adherence and get specific support for the daily challenges many people with high blood pressure face.
