Two injections a year could replace daily blood pressure pills, major review suggests

A new analysis published in The Lancet indicates that treatment for high blood pressure might be on the verge of a significant change, with the possibility of managing hypertension with only two injections per year instead of daily tablets.

Long-standing management of hypertension has relied on patients taking daily oral medication, but control rates globally remain low despite decades of available drugs. The Lancet review highlights several late-stage therapies now undergoing global clinical trials that work differently from conventional treatments.

One of the most advanced therapies discussed is Zilebesiran, being developed by Roche and Alnylam Pharmaceuticals. It uses small interfering RNA (siRNA) technology to reduce production of angiotensinogen — a protein made in the liver that plays a central role in regulating blood pressure. A single subcutaneous injection in trials can suppress systolic blood pressure for up to six months.

Another experimental approach, Ziltivekimab from Novo Nordisk, is designed to target inflammatory pathways linked to cardiovascular risk, while other strategies aim for more precise control of hormones such as aldosterone that influence salt and fluid balance.

Researchers emphasize that poor adherence to daily medications has long been a major barrier to effective blood pressure control. In real-world settings many people miss doses or discontinue treatment due to side effects, complexity of multiple pills, or “pill fatigue.” Long-acting injectables could help close this gap if they prove safe and effective over the long term.

While early trial results show a generally favourable safety profile, experts caution that hypertension is a lifelong condition. Large-scale trials and extended follow-up are still needed before these injectable treatments could be approved for routine use.

The cost of such therapies may also influence how widely they can be adopted, particularly in low- and middle-income countries where hypertension is common and access to affordable care remains a challenge.

Currently recommended oral antihypertensives include combinations of ACE inhibitors, angiotensin receptor blockers, calcium channel blockers and diuretics, which can be highly effective when taken consistently.

The new injectable therapies aim to reduce the burden of daily medication and improve long-term control, should ongoing studies confirm both safety and sustained benefit.

Globally, hypertension affects about 1.4 billion adults and remains a leading cause of heart attack, stroke and early death. Many people living with the condition are unaware they have it, and among those diagnosed fewer than one in four achieve recommended blood pressure targets.