A twice-yearly shot to control BP? Hypertension care is set to change

By Admin

14 Feb, 2026

Introduction: A Seismic Shift in Cardiology

The “silent killer” may finally meet a powerful new shield   one injection that protects for six months at a time.

What sounds futuristic is now edging closer to reality. Instead of swallowing pills every day, patients with hypertension may soon receive just two injections a year to keep their blood pressure in check. With multiple long-acting injectable therapies in late-stage clinical trials and eyeing commercial launch, hypertension care could be on the brink of its biggest transformation in decades.

A recent review published in The Lancet underscores how significant this shift could be. Despite the availability of effective antihypertensive drugs for years, global blood pressure control remains stubbornly poor. The problem is not a lack of medicines   it is a failure of systems, adherence and long-term engagement.

Understanding the Silent Killer

Hypertension continues to be the leading cause of heart attacks, strokes and premature death worldwide.

According to the World Health Organization (WHO), hypertension is defined as blood pressure at or above 140 mm Hg systolic and/or 90 mm Hg diastolic.

• Systolic pressure measures the force exerted when the heart pumps blood into the arteries.
  
  

• Diastolic pressure reflects the pressure when the heart rests between beats.
  
  

• Normal blood pressure is below 120/80 mm Hg.
  
  

Because it often produces no symptoms until complications occur, hypertension has earned its reputation as the “silent killer.”

Huge Burden of the Silent Killer

The global burden is staggering. As of 2024–2025, an estimated 1.4 billion adults aged 30 to 79   about one in three   live with hypertension. Nearly 44% of them are unaware they even have the condition. Among those diagnosed, fewer than one in four have their blood pressure adequately controlled.

India mirrors this crisis.

The Indian Council of Medical Research (ICMR)-INDIAB study published in 2023 estimated that 315 million Indians   or 35.5% of the population   have hypertension. A secondary analysis of National Family Health Survey-5 (NFHS-5) data showed that nearly half of hypertensive men and over a third of hypertensive women in India do not have their blood pressure under control.

These figures highlight a critical gap between diagnosis and effective management.

Gold Standard Care   And Its Limitations

For decades, hypertension management has relied on daily oral medications. Current guidelines typically recommend combinations of two or more drugs to reach target blood pressure levels, including:

• ACE inhibitors to relax blood vessels
  
  

• Angiotensin receptor blockers paired with calcium channel blockers
  
  

• Thiazide or thiazide-like diuretics to eliminate excess salt and water
  
  

In theory, these regimens work well.

In practice, adherence is the Achilles’ heel. Many patients also live with diabetes, obesity or abnormal cholesterol levels, resulting in polypharmacy   multiple pills taken multiple times a day. Over time, missed doses, side effects and “treatment fatigue” reduce effectiveness.

Therapeutic inertia   where medications are not intensified despite uncontrolled blood pressure   further compounds the problem.

The Rise of Long-Acting Injectables

This is where the new class of long-acting injectable therapies enters the picture.

According to Dr Mohit Gupta, cardiologist and clinical researcher at G B Pant Hospital and University College of Medical Sciences, Delhi, the field is moving decisively toward therapies administered just twice a year.

Unlike conventional drugs that work downstream to lower blood pressure numbers, these newer agents target upstream molecular pathways that drive hypertension itself.

Targeting the Root Causes

One promising approach involves small interfering RNA (siRNA) agents that inhibit angiotensinogen synthesis in the liver. By silencing this protein, these drugs dampen the renin–angiotensin system   a key hormonal pathway regulating blood pressure.

Zilebesiran, developed by Roche and Alnylam Pharmaceuticals, is currently in global phase 3 trials after encouraging phase 2 results.

Another candidate is Ziltivekimab by Novo Nordisk. This monoclonal antibody targets inflammatory pathways linked to cardiovascular risk. Since chronic inflammation contributes to vascular dysfunction and hypertension, modulating this pathway may reduce both blood pressure and overall cardiovascular risk.

Emerging therapies are also exploring selective modulation of aldosterone   a hormone that increases sodium and water retention, thereby raising blood pressure. More precise control of this pathway could provide sustained benefits with fewer side effects.

Why Twice-Yearly Injections Matter

The appeal of these therapies lies in durability.

• Consistent drug exposure
  
  

• Elimination of daily pill burden
  
  

• Improved adherence
  
  

• Potentially more stable blood pressure control
  
  

In theory, this could translate into fewer heart attacks and strokes over time.

If successful, such treatments could redefine hypertension care   shifting from daily compliance challenges to long-acting, precision-based interventions. For preventive cardiology, it represents a decisive rethink.

A Word of Caution

Yet, enthusiasm is tempered by caution.

Cost remains a major concern. The experience with Inclisiran   an injectable LDL cholesterol-lowering therapy introduced in India in 2024   offers perspective. Priced between Rs 1.8 lakh and Rs 2.4 lakh annually, it remains out of reach for many patients.

If hypertension injectables follow similar pricing, accessibility could become a serious barrier, particularly in low- and middle-income countries where the burden of disease is highest.

Long-term safety is another unresolved question. Hypertension is a lifelong condition, and patients may require therapy for decades. Robust evidence on rare adverse events, long-term outcomes and safety across diverse populations will be essential.

Dr Dorairaj Prabhakaran, scientist and cardiologist at the Centre for Disease Control, a WHO collaborating centre with ICMR, stresses that while once- or twice-yearly injections could simplify management, careful scientific evaluation must precede widespread adoption.

The Road Ahead

The promise is undeniable.

A twice-yearly injection that reliably controls blood pressure could ease treatment burden for millions, improve adherence and reduce the global toll of heart disease and stroke.

But as these therapies approach regulatory review, the true test will lie beyond clinical efficacy   in affordability, accessibility and sustained safety.

Hypertension care may indeed be on the verge of a revolution. Whether it becomes a global solution or a limited innovation will depend on how science, policy and healthcare systems respond in the years ahead.