Recent advances in hypertension genomics and RNA interference-based therapeutics: the key to future management?

Abstract

INTRODUCTION Hypertension is a major contributor to cardiovascular morbidity and mortality. Given the suboptimal control rates with conventional antihypertensive medication, novel approaches are warranted. In the era of precision medicine, integrating hypertension genomics into diagnostic and therapeutic approaches may greatly advance hypertension management. AREAS COVERED This narrative review summarizes recent advances in hypertension genomics and discusses their potential integration into current diagnostic and risk assessment algorithms toward personalized hypertension management. We searched PubMed for relevant publications up to January 2026. Pharmaceutical exploitation of genomic advances has led to the development of molecules utilizing Ribonucleic Acid (RNA) interference. Zilebesiran is an investigational RNA interference therapeutic agent resulting in durable silencing of angiotensinogen gene synthesis. Clinical trials conducted so far demonstrate that a single subcutaneous injection of zilebesiran is well-tolerated and induces sustained reductions in blood pressure (BP) for several months. EXPERT OPINION Recent advances in hypertension genomics may fundamentally reshape cardiovascular prevention and therapy over the next decade. Among emerging RNA-based therapeutic candidates, zilebesiran leads the way in translating these molecular advances into clinical practice. Results of the ongoing phase 3 cardiovascular outcomes trial are eagerly anticipated, and could potentially reshape the field of cardiovascular therapeutics by advancing genetically targeted approaches.