A Twice-Yearly Shot to Control BP? : Hypertension — often called the “silent killer” — could soon face a game-changing innovation. For decades, managing high blood pressure has meant swallowing pills daily, often multiple times a day. But that long-standing model may be about to change dramatically. Scientists are now developing long-acting injectable therapies that could control blood pressure with just two injections a year.
What once sounded futuristic is now advancing through late-stage clinical trials. If successful, these therapies could represent one of the most significant shifts in cardiology in decades — transforming hypertension care from a daily adherence challenge into a long-acting, precision-based intervention.
The Global Burden of Hypertension
The scale of the problem is enormous. According to the World Health Organization, hypertension is defined as blood pressure at or above 140 mm Hg systolic and/or 90 mm Hg diastolic. Normal blood pressure is below 120/80 mm Hg.
As of 2024–2025, an estimated 1.4 billion adults aged 30 to 79 — roughly one in three globally — are living with hypertension. Alarmingly, nearly 44 percent are unaware they have the condition. Among those diagnosed, fewer than one in four achieve adequate blood pressure control.
India reflects this crisis. The Indian Council of Medical Research–INDIAB study (2023) estimated that 315 million Indians — about 35.5 percent of the population — have hypertension. A secondary analysis of National Family Health Survey-5 data showed nearly half of hypertensive men and over a third of hypertensive women do not have their blood pressure under control.
Hypertension remains the leading cause of heart attacks, strokes, kidney disease, and premature death worldwide.
Why Current Treatments Fall Short
Modern antihypertensive medications are effective. Standard regimens typically include:
- ACE inhibitors
- Angiotensin receptor blockers
- Calcium channel blockers
- Thiazide or thiazide-like diuretics
Guidelines often recommend combinations of two or more drugs to achieve optimal control.
In theory, these medications work well. In practice, adherence is the Achilles’ heel.
Many patients also have diabetes, obesity, or abnormal cholesterol levels, leading to polypharmacy — multiple pills taken daily. Over time, missed doses, side effects, and “treatment fatigue” erode effectiveness. Therapeutic inertia — where doctors do not intensify therapy despite uncontrolled readings — compounds the issue.
The problem is not a lack of medicines. It is a failure of systems, long-term engagement, and consistent adherence.
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The Science Behind Twice-Yearly Injections
The emerging injectable therapies work differently from traditional drugs.
Instead of simply lowering blood pressure downstream, these agents target upstream molecular pathways that drive hypertension.
1. Silencing Angiotensinogen with siRNA
One of the most advanced candidates is Zilebesiran, developed by Roche and Alnylam Pharmaceuticals.
Zilebesiran uses small interfering RNA (siRNA) technology to inhibit angiotensinogen production in the liver. Angiotensinogen is a key component of the renin–angiotensin system, a hormonal cascade central to blood pressure regulation.
By silencing this pathway at its source, the drug may provide sustained blood pressure reduction with a single injection lasting up to six months. It is currently in global Phase 3 trials after promising Phase 2 results.
2. Targeting Inflammation
Another candidate is Ziltivekimab, developed by Novo Nordisk.
This monoclonal antibody targets inflammatory pathways increasingly recognised as contributors to vascular dysfunction and cardiovascular risk. By reducing inflammation, it may not only lower blood pressure but also decrease overall cardiovascular risk.
3. Aldosterone Modulation
Other investigational approaches focus on more precisely controlling aldosterone, a hormone that increases sodium and water retention. Excess aldosterone raises blood volume and pressure. Targeted modulation of this pathway could offer sustained control with fewer side effects.
Why This Could Be Transformational
The appeal of twice-yearly injectables lies in durability and simplicity.
- Ensures consistent drug exposure
- Eliminates daily pill burden
- Reduces missed doses
- Potentially improves long-term cardiovascular outcomes
In preventive cardiology, this represents a fundamental shift — from daily compliance battles to long-acting, precision medicine.
For patients who struggle with medication adherence, a biannual injection administered under medical supervision could dramatically improve control rates.
A Word of Caution
Excitement, however, is tempered by critical concerns.
Cost Barriers
The experience with Inclisiran, introduced in India in 2024 for lowering LDL cholesterol, is instructive. Priced between ₹1.8 lakh and ₹2.4 lakh annually, it remains inaccessible to many.
If hypertension injectables are similarly priced, they could remain out of reach in low- and middle-income countries — where hypertension burden is highest.
Long-Term Safety
Hypertension is lifelong. Patients may require these therapies for decades.
While early trials show promising safety profiles, long-term data on rare adverse events and sustained use across diverse populations will be essential before widespread adoption.
Experts emphasize that enthusiasm must be balanced with rigorous scientific evaluation.
The Bigger Picture
If proven safe, effective, and affordable, twice-yearly blood pressure injections could:
- Improve global blood pressure control rates
- Reduce heart attacks and strokes
- Ease patient treatment burden
- Simplify healthcare delivery
But clinical efficacy alone will not determine success. Affordability, accessibility, regulatory approval, and real-world safety monitoring will be equally critical.
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A Seismic Shift in the Making?
Hypertension care has relied on daily oral therapy for decades. A move toward long-acting molecular interventions represents more than a new drug — it marks a philosophical shift in chronic disease management.
The “silent killer” may soon meet a powerful new shield. Whether this innovation reshapes global cardiology will depend not just on science, but on how equitably it can be delivered to the billions who need it most.
For now, the future of blood pressure treatment appears closer than ever to being measured not in daily doses — but in twice-yearly protection.
