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A new review published in The Lancet has signalled what could become a major shift in the treatment of high blood pressure, including the possibility of long-acting therapies that may require as few as two injections a year.
The review underlines a stark reality: “Despite the availability of effective antihypertensive therapies, global blood pressure control rates remain unacceptably low.”
Researchers attribute this gap not to a lack of medicines, but to systemic challenges. “Contributing factors, such as low treatment adherence, therapeutic inertia, and rising multimorbidity, underscore the need for innovative approaches to improve hypertension care,” the authors note.
Beyond daily pills
For decades, hypertension treatment has largely relied on daily oral drugs targeting well-known pathways. But the Lancet review highlights a new class of therapies that move beyond conventional drug mechanisms.
Among the most promising are “small interfering RNA agents that inhibit angiotensinogen synthesis as a novel approach to inhibit the renin–angiotensin system.” These RNA-based drugs are designed to silence the production of specific proteins involved in raising blood pressure, potentially allowing for long-acting control with infrequent dosing.
The review also points to “new strategies to more selectively modulate aldosterone, such as aldosterone synthase inhibitors and non-steroidal mineralocorticoid receptor antagonists,” as well as “growing interest in therapies to enhance the action of the natriuretic peptide system.”
Such approaches could address one of the biggest challenges in hypertension care: adherence. If patients no longer need to remember daily pills — and instead receive periodic injections under medical supervision — control rates could improve substantially.
However, the authors caution against over-optimism. “Although these innovations present valuable therapeutic opportunities, their benefits must be carefully balanced against considerations of safety, cost, clinical outcomes, and equitable access — all of which are crucial to reducing the residual burden of cardiovascular and chronic kidney disease.”
A global crisis of control
The urgency of innovation is underscored by data from the World Health Organization (WHO).
According to WHO, an estimated 1.4 billion adults aged 30–79 years were living with hypertension in 2024 — representing 33% of the population in that age group. Two-thirds of them live in low- and middle-income countries.
Even more worrying, 600 million adults (44%) are unaware they have the condition. While roughly 630 million (44%) are diagnosed and treated, only about 320 million (23%) have their blood pressure under control.
Hypertension — defined as persistent readings of 140/90 mmHg or higher — is often symptomless, yet it is a major cause of heart attack, stroke, kidney failure and premature death worldwide. WHO has set a global target to reduce uncontrolled hypertension by 25% between 2010 and 2025, but progress remains uneven.
India’s pressing challenge
In India, the burden is both large and under-managed. A 2023 position statement by the Indian Society of Hypertension, published in the Journal of Human Hypertension, highlights the urgency for India-specific strategies.
The paper reports that hypertension affects 24% of Indian men and 21% of women, while pre-hypertension affects nearly half of men (49%) and 39% of women. Alarmingly, “7% of school-going children in India have hypertension, especially in urban and overweight children.”
Awareness and treatment gaps are significant. “Only 57% of women and 38% of men have been diagnosed with hypertension; among them, only a fraction receive appropriate medication,” the authors state. Overall, control rates stand at just 15%, with wide regional variation.
The position statement emphasizes that even modest reductions could yield major public health gains: “At the total population level, reducing systolic blood pressure (SBP) by 2 mm Hg may significantly affect cardiovascular disease.”
