Daga Pawan, Singh Gurnoor, Menon Tushar, Sztukowska Maryta, Kalra Dinesh K
Department of Internal Medicine, University of Louisville School of Medicine, Louisville, KY, USA.
Division of Cardiology, Department of Medicine, Rudd Heart and Lung Center, University of Louisville School of Medicine, 201 Abraham Flexner Way, Suite 600, Louisville, KY, 40202, USA.
Mol Diagn Ther. 2025 Jan;29(1):25-41. doi: 10.1007/s40291-024-00747-5. Epub 2024 Oct 14.
Hypertension (HTN), often dubbed the "silent killer," poses a significant global health challenge, affecting over 1.3 billion individuals. Despite advances in treatment, effective long-term blood pressure (BP) control remains elusive, necessitating novel therapeutic approaches. Poor control of BP remains a leading cause of cardiovascular morbidity and mortality worldwide and is becoming an even larger global health problem due to the aging population, rising rates of obesity, poorer dietary patterns and overall cardiometabolic health, and suboptimal rates of patient adherence and optimal BP control. Ribonucleic acid interference (RNAi) technology, which leverages the body's natural gene-silencing mechanism, has emerged as a promising strategy for several diseases and has recently been tested for its antihypertensive effects. We systematically reviewed peer-reviewed articles from databases including PubMed, EMBASE, and Scopus for studies examining RNAi's role in managing HTN, focusing on mechanisms, clinical utility, and safety profile. Key early-phase trials of some RNAi-leading candidate drugs are detailed. Also highlighted are challenges such as target specificity, delivery mechanisms, durability of effect, and immunogenicity. We conclude by summarizing how RNAi has a significant potential role in HTN therapy due to their unique benefits, such as long-term duration of action, infrequent dosing, and lack of major side effects.
高血压(HTN)常被称为“无声杀手”,是一项重大的全球健康挑战,影响着超过13亿人。尽管治疗方面取得了进展,但有效的长期血压(BP)控制仍然难以实现,因此需要新的治疗方法。血压控制不佳仍然是全球心血管发病和死亡的主要原因,并且由于人口老龄化、肥胖率上升、饮食模式较差以及整体心脏代谢健康状况不佳,以及患者依从性和最佳血压控制率不理想,这一问题正成为一个日益严重的全球健康问题。核糖核酸干扰(RNAi)技术利用人体自然的基因沉默机制,已成为治疗多种疾病的一种有前景的策略,最近还对其降压效果进行了测试。我们系统地回顾了来自包括PubMed、EMBASE和Scopus在内的数据库中的同行评审文章,以研究RNAi在管理高血压中的作用,重点关注其机制、临床应用和安全性。详细介绍了一些RNAi领先候选药物的关键早期试验。还强调了诸如靶点特异性、递送机制、作用持久性和免疫原性等挑战。我们通过总结RNAi如何因其独特的优势(如长期作用持续时间、给药频率低和缺乏主要副作用)在高血压治疗中具有重要的潜在作用来得出结论。