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 their risk of heart attack could soon be a thing of the past – thanks to a twice-yearly jab that ‘switches 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 trial results announced this weekend.

Most patients saw blood pressure drops after one injection that could translate to a 20 per cent or more reduction in their chances of suffering a heart attack, stroke or other cardiac event.

Some in the trials have been able to quit all other blood pressure medication and there were few if any side-effects recorded.

Experts say the injections are so simple to give they could be self-administered, much like commonly taken diabetes drugs.

The news, unveiled at the American Heart Association Scientific Sessions, in Philadelphia, was welcomed by cardiologists.

Although the early-stage study involved just a few hundred patients, the data was hailed as a potential paradigm shift in treatment of high blood pressure, a condition that’s responsible for half of all heart attacks and strokes.

Chicago-based heart expert Professor George Bakris, who was involved in the trials, said the idea of ditching ‘the burden’ of daily tablets for two injections a year was so popular his patients were ‘standing in line’ to get the drug.

‘If this lives up to its promise, it will represent a huge shift in treatment,’ he said, adding that larger trials were now needed.

High blood pressure, medically known as hypertension, affects 14.4 million people in the UK – a quarter of British adults. However the condition rarely has noticeable symptoms and a staggering 4 million Britons are estimated to be undiagnosed, as they have never been tested.

While anyone can be affected, hypertension is more likely in those who are overweight, eat a diet high in salt and exercise little. Smokers, drinkers, the over-65s and those of African or Caribbean descent are also at greater risk.

In addition it is estimated that more than half of all patients on medication still have blood pressure high enough to put their health at risk. Dr Manish Saxena, a hypertension expert at Queen Mary University London who has been involved in clinical trails of zilebesiran, said: ‘High blood pressure is a leading risk factor for heart attacks and strokes, but many patients remain poorly controlled.

‘Patients forget to take their daily medication or struggle due to side effects.’

While patients with mild hypertension may be able to reverse the problem with lifestyle changes – increasing exercise and reducing their salt intake – many ultimately require life-long medication. A wide variety of blood pressure drugs are available but some patients may suffer swelling of the legs and hands, headaches, stomach issues, sexual dysfunction and even hair loss, said Dr Saxena. ‘This new injection seems not to cause any significant problems,’ he added.

Blood pressure can increase at night in patients on regular medication, however zilebesiran keeps blood pressure stable round the clock, further reducing heart risk.

Dr Saxena said: ‘An injection once every six months is easier for patients than daily tablets, and given the pressure the NHS has been under this is just the sort of solution we need.

‘There is no reason this couldn’t be self-administered, much like injectable diabetes medication such as insulin. If it’s successful in bigger 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 producing antiotensinogen, a protein produced by the liver.

Antiotensinogen is needed to manufacture angiotensin, a hormone that narrows blood vessels leading to raised blood pressure.

It is believed that people with high blood pressure have too much angiotensin, and zilebesiran reduces the amount in circulation.

Several existing drugs 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 jab inclisiran, which was approved for NHS use in 2021.

These drugs are highly targeted, only acting within the liver, which is the reason there are few side- effects, say experts.

Results are seen within three to four weeks.

At present, the studies have involved patients only with mild to moderate high blood pressure.

‘We now hope to see bigger trials of patients with higher blood pressure and more difficult to treat problems,’ said Dr Saxena. ‘Patients have been very positive. They like the fact their blood pressure is controlled with very little medication.’

To stent or not to stent? The verdict

By Barney Calman, Health Editor for The Mail on Sunday 

Thousands of Britons undergo procedures every year to open up narrow heart arteries, but there is heated debate among doctors on whether they are actually beneficial to many.

The most common is coronary angioplasty, where a tiny metal tube – called a stent – is implanted into a damaged blood vessel to restore circulation.

The treatment is known to reduce the chances of heart attacks in previous sufferers, but they are also offered to patients battling with debilitating angina chest pain.

Until now, there has been conflicting data on whether stents help this group, or if prescribing anti-angina medication is a lower-risk and equally effective option. But this may all change thanks to trial results unveiled 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 three-month duration of the trial, with many reporting less chest pain, better quality of life and an increased ability to exercise without needing to take medication.

Importantly, half of the 300 or so patients in the trial had a placebo procedure, being fully sedated in the operating theatre but not actually given a stent. This was to make sure benefits reported were actually due to the implant and not a placebo effect – in which patients feel better simply because they’ve had surgery.

The participants who had a real stent implanted saw a significant improvement over those in the placebo group.

‘Many patients don’t want to take high levels of anti-angina medication long-term due to side effects and the burden of taking pills every day,’ said Imperial College London cardiologist Dr Rasha Al-Lamee, who led the study. ‘This means that we can now offer patients a choice to have angioplasty as a primary treatment.’