Jab twice a year could send high blood pressure into reverse, new trial finds – replacing the need for daily pills
Daily pills taken by millions of Britons to reduce the risk of heart attack could soon be a thing of the past thanks to a six-monthly jab that ‘turns off’ high blood pressure.
A single dose of the drug, called zilebesiran, can control the condition for up to six months and causes few side effects, according to study results announced this weekend.
Most patients saw a drop in blood pressure after one injection, which could translate into a 20 percent or more reduction in their chances of having a heart attack, stroke or other heart disease.
Some in the studies were able to stop taking all other blood pressure medications and few or no side effects were recorded.
Experts say the injections are so easy to give that they can be self-administered, just like commonly used diabetes medications.
A single dose of the drug, called zilebesiran, can control high blood pressure for up to six months and causes few side effects, according to study results announced this weekend.
Chicago-based heart expert Professor George Bakris said the idea of two injections a year was so popular that his patients were ‘lining up’ to get the drug
The news, unveiled at the American Heart Association Scientific Sessions in Philadelphia, was welcomed by cardiologists.
Although the early-stage study involved only a few hundred patients, the data was hailed as a potential paradigm shift in the treatment of high blood pressure, a condition responsible for half of all heart attacks and strokes.
Chicago-based heart expert Professor George Bakris, who was involved in the studies, said the idea of ’giving up the burden’ of daily tablets for two injections a year was so popular that his patients were ‘queuing up’ to take it to get medicine.
“If this delivers on its promise, it will represent a huge shift in treatment,” he said, adding that larger studies were now needed.
High blood pressure, medically known as hypertension, affects 14.4 million people in Britain – a quarter of British adults. However, the condition rarely has noticeable symptoms and it is estimated that as many as 4 million Britons go undiagnosed because they have never been tested.
Although anyone can suffer from it, the risk of high blood pressure is greater in people who are overweight, who eat a diet high in salt and who exercise little. Smokers, drinkers, people over 65 and people of African or Caribbean descent are also at greater risk.
In addition, it is estimated that more than half of all patients taking medications still have blood pressure high enough to endanger their health. Dr. Manish Saxena, a hypertension expert at Queen Mary University London who has been involved in clinical trials of zilebesiran, said: ‘High blood pressure is a major risk factor for heart attacks and strokes, but many patients remain poorly controlled.
‘Patients forget to take their daily medication or suffer from side effects.’
About 100,000 stents are placed in the UK every year. Most are given when patients are having a heart attack to prevent a second attack – and when used in this way they are a proven lifesaver, dramatically improving health and preventing an early death.
Although patients with mild hypertension may be able to reverse the problem with lifestyle changes – more exercise and less salt intake – many ultimately require lifelong medication. There are a wide variety of blood pressure medications available, but some patients may experience swelling of the legs and hands, headaches, stomach problems, sexual dysfunction and even hair loss, Dr. Saxena said. “This new injection does not appear to cause any significant problems,” he added.
Blood pressure can rise at night in patients taking regular medications, but zilebesiran keeps blood pressure stable 24 hours a day, further reducing heart risk.
Dr. Saxena said: ‘An injection every six months is easier for patients than daily tablets, and given the pressures the NHS is under, this is exactly the kind of solution we need.
‘There’s no reason why this couldn’t be self-administered, just like injectable diabetes medications like insulin. If successful in larger studies, a treatment like this has the potential to become a new gold standard.’
Zilebesiran is a new type of drug known as small interfering RNA (siRNA). It works by switching off the gene responsible for the production of antiotensinogen, a protein produced by the liver.
Antiotensinogen is necessary for the production of angiotensin, a hormone that constricts blood vessels, leading to increased blood pressure.
It is believed that people with high blood pressure have too much angiotensin, and zilebesiran reduces the amount in the bloodstream.
Several existing medications used to treat hypertension target angiotensin, but this is the first drug to cut off production at the source.
Similar technology is used in the cholesterol-lowering injection inclisiran, which was approved for use by the NHS in 2021.
These drugs are highly targeted and work only in the liver, which is why there are few side effects, experts say.
Results are seen within three to four weeks.
Currently, the studies only involve patients with mild to moderate high blood pressure.
‘We now hope to see larger studies in patients with higher blood pressure and more difficult to treat problems,’ said Dr Saxena. ‘Patients are very positive. They like the fact that their blood pressure can be controlled with very few medications.”
To stent or not to stent? The verdict
By Barney Calman, health editor for The Mail on Sunday
Thousands of Britons undergo procedures to open narrow heart arteries every year, but there is heated debate among doctors over whether these are actually beneficial for many.
The most common is coronary angioplasty, in which a small metal tube – called a stent – is implanted into a damaged blood vessel to restore circulation.
The treatment is known to reduce the risk of heart attacks in previous patients, but they are also offered to patients struggling with debilitating angina chest pain.
Stents are small mesh tubes inserted into weak or narrow arteries and other passageways to keep them open
So far, there is conflicting data on whether stents help this group, and whether prescribing anti-angina medications is a less risky and equally effective option. But this could all change thanks to study results revealed this weekend, in which angina patients reported significant improvements in symptoms and quality of life after angioplasty alone.
The effect of the stents was immediate and lasted for at least the duration of the three-month trial, with many reporting less chest pain, better quality of life and an increased ability to exercise without having to take medications.
Importantly, half of the approximately 300 patients in the study underwent a placebo procedure, in which they were completely anesthetized in the operating room, but did not actually receive a stent. This was to ensure that the reported benefits were actually due to the implant and not a placebo effect – where patients feel better simply because they have had surgery.
The participants who had a real stent implanted saw a significant improvement compared to those in the placebo group.
“Many patients do not want to take large amounts of anti-anginal medications in the long term because of the side effects and the burden of taking pills every day,” said cardiologist Dr. Rasha Al-Lamee of Imperial College London, who led the study. ‘This means that we can now offer patients the choice to undergo angioplasty as a primary treatment.’