Changing the paradigm of long-term blood pressure control: a systematic review of novel therapies

Novel drug and device therapies have the potential to achieve long-term control of blood pressure (BP) and thereby overcome the barriers of nonadherence and undertreatment. We propose that ideal BP lowering therapy should meet six key criteria: (i) achieve a clinically relevant BP reduction; (ii) durable BP reduction; (iii) be well tolerated; (iv) have the ability to be safely combined with other BP lowering treatments; (v) have high patient acceptability and (vi) be cost-effective and simple to use to maximize scalability. In this paper, we systematically review emerging solutions for long-term control of BP including antibody-based therapies, sRNA therapies, and DNA-based gene editing which target the renin angiotensin system, and implant therapies, and interventional approaches (renal denervation and baroreceptor activation therapies). These novel therapies may substantially complement and, in some settings, even replace current antihypertensive therapies. Implementation will require significant progress in overcoming technological-, systems-, prescriber- and patient-level barriers.