HYPERTENSION is a global health challenge affecting about 30-35 per cent of adults globally and is associated with many potential complications and poses significant economic burden to national economies and families.

Many individuals with hypertension remain untreated or inadequately treated. Only about 20 per cent of hypertensives are controlled on medications. Despite widescale availability of effective and well-tolerated medications for hypertension, up to 80 per cent of hypertensive individuals have uncontrolled or poorly controlled hypertension.

Uncontrolled hypertension is a leading cause of death and disability, especially in low- and middle-income countries. Controlling or treating hypertension to target can potentially save many lives and reduce the economic burden associated with hypertension and its many complications. A major reason for inadequate or poor hypertension control is medication non-compliance. Community surveys show that only 50 per cent of patients continue to take anti-hypertensive drugs after one year. It is reasonable to presume that improving compliance in the treatment of hypertension would lead to better control of hypertension and reduction in cardiovascular risks.

There is evidence that increasing the number of patients effectively treated for hypertension to levels observed in high-performing countries could prevent 76 million deaths, 120 million strokes, 79 million heart attacks, and 17 million cases of heart failure globally over the next 25 years.

Finding a sustainable and effective treatment with high level of compliance has been a major quest for doctors treating patients with hypertension. An exciting new research work suggests that we may be getting closer to achieving this objective. In a recently concluded study, a single injection of the investigational anti-hypertensive agent Zilebesiran (Alnylam Pharmaceuticals) effectively lowered blood pressure in adults with mild to moderate hypertension for up to six months. The findings of the KARDIA-1 study were presented this month at the American Heart Association Annual Scientific Sessions held in Philadelphia, USA. The study demonstrated that either quarterly or biannual doses of Zilebesiran effectively and safely reduced blood pressure in patients with hypertension and suggest that Zilebesiran could potentially improve compliance in patients with hypertension and could ultimately improve outcomes.

Zilebesiran is a subcutaneous RNA interference therapeutic that binds to a hepatic receptor, leading to an interruption of pro-hypertensive processes. The KARDIA-1 trial investigated the safety and efficacy of different doses of Zilebesiran in 394 patients with mild to moderate hypertension over a six-month follow-up period. (56 per cent men, 44 per cent women, 25 per cent black).

Ambulatory systolic blood pressure measured over 24 hours was significantly decreased with Zilebesiran. This effect was seen in both daytime and night-time measurements. Furthermore, patients receiving Zilebesiran were more likely to achieve 24-hour average systolic blood pressure measurements ≤ 130 mm Hg at six months.

These findings are very encouraging and suggest that, in the future, we may have an alternative strategy to treat hypertension with an injectable drug that can achieve robust and sustained blood pressure lowering for up to six months, which should improve compliance, increase efficacy, and protect against complications. There is hope that further investigations and refinements would lead to intermittent subcutaneous dosing and administration at home as a desired possibility in the future.

Dr Ernest Madu, MD, FACC and Dr Paul Edwards, MD, FACC are consultant cardiologists for the Heart Institute of the Caribbean (HIC) and HIC Heart Hospital. HIC is the regional centre of excellence for cardiovascular care in the English-speaking Caribbean and has pioneered a transformation in the way cardiovascular care is delivered in the region. HIC Heart Hospital is registered by the Ministry of Health and Wellness and is the only heart hospital in Jamaica. Send correspondence to info@caribbeanheart.com or call 876-906-2107.