New injection every 6 months... lowers high blood pressure

A team from Queen Mary University of London and the University of Oxford has succeeded in developing a new drug administered as a subcutaneous injection every six months, which lowers systolic blood pressure by 15 to 20 mmHg and diastolic blood pressure by 10 to 12 mmHg, equivalent to the combined effect of two to three oral medications.

According to the study published in the New England Journal of Medicine (NEJM) on April 4, 2026, the drug (temporary name Zilebesiran-2) works by inhibiting angiotensinogen in the liver via an RNA interference mechanism, thereby preventing the formation of angiotensin II, the body’s most potent vasoconstrictor. The effect begins within a week of the injection and lasts for 180 to 210 days, with a gradual decline toward the end of the period.

Key findings from the Phase III clinical trial, which involved 2,000 patients across 15 countries, include:

• Efficacy: Six months after the first injection, systolic blood pressure dropped below 130 mmHg (the therapeutic target) in 85 percent of patients, compared to only 45 percent in the group continuing daily oral medications (such as lisinopril and amlodipine).

• Adherence: Fewer than 2 percent of patients in the injection group missed their second dose after six months, whereas 40 percent of the oral medication group admitted to forgetting to take at least one pill per week.

• Side effects: These were mild (injection site redness in 10 percent, mild headache in 5 percent). No cases of angioedema or renal toxicity were recorded. In comparison, 15 percent of the oral medication group suffered from chronic dry cough (due to ACE inhibitors) or ankle swelling (due to calcium channel blockers).

• Sustainability: After 12 months (two injections), 80 percent of patients maintained normal blood pressure, while 70 percent of the oral medication group required a dose increase or the addition of a second drug.

The drug is expected to receive approval from the U.S. Food and Drug Administration (FDA) and the European Medicines Agency (EMA) by mid-2027, with market launch anticipated in early 2028. The estimated cost per dose will be $200–$300 (i.e., $400–$600 annually), which is higher than the cost of inexpensive oral medications ($20–$50 annually), but it may prove more cost-effective when accounting for the expenses of complications arising from poor adherence (such as strokes and kidney failure).

However, physicians warn that the injection is not suitable for all patients: it is not administered to pregnant women or those with known allergies, nor is it appropriate for patients with chronic hypotension or bilateral renal artery stenosis.

High blood pressure affects 1.3 billion people worldwide and is the leading cause of premature death (10 million deaths annually). This drug could represent the first-ever “anti-hypertension vaccine” in history.