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Meta-Analysis of Semaglutide and BP
Quick Takes
- Systolic BP is lowered by about 5 mm Hg in patients taking semaglutide for weight loss.
- The full antihypertensive effect of semaglutide may be greater, as patients often had their antihypertension medications decreased during the trials.
- Semaglutide may be a particularly useful medication in patients with obesity and hypertension.
Study Questions:
Does use of semaglutide decrease blood pressure (BP) and, if so, does it decrease it more in people with higher starting BPs? Also, can the BP drop be attributed solely to the weight loss?
Methods:
Individual patient information was aggregated from three randomized clinical trials using semaglutide 2.4 mg over about 16 months. The 3,136 participants were separated into four categories: those with a hypertension diagnosis, those with systolic BP (SBP) >130 mm Hg, those with SBP >140 mm Hg, and those with resistant hypertension. Weight was monitored and compared to placebo therapy.
Results:
In patients using semaglutide, body mass index (BMI) decreased by approximately 15% and systolic BP by about 4.8 mm Hg. Escalation of BP treatment in the hypertension group occurred in 5.7% of those on semaglutide and 7.6% of those on placebo. Escalation was slightly more common in the resistant hypertension group. De-escalation of BP medication in the hypertension group occurred in 10.9% on semaglutide and 5.2% on placebo. These findings were similar among all the groups except the resistant hypertension group, where 26.9% had their BP medication decreased, compared to 3% on placebo.
Conclusions:
Use of semaglutide for 68 weeks yields a weight loss of about 15% BMI and a drop in BP of 4.8 mm Hg. The full magnitude of the potential BP drop with semaglutide is probably masked by decreases in number of BP medications in patients in the active treatment arms.
Perspective:
Hypertension and obesity remain prevalent and concerning public health issues, and the use of medications such as semaglutide may yield a particular benefit in improving overall cardiovascular health that is partially attributable to BP drop. This analysis shows a consistent 5 mm Hg SBP drop in patients on semaglutide nearly regardless of their starting BP. It is well-accepted that BP medications, in general, provide a greater SBP lowering effect on patients with higher BP compared to lower BPs. Therefore, this finding, at first, is a bit unusual until one notes that BP medications are getting lowered in the patients that are “successful” at weight loss with semaglutide. With all of these uncontrollable variables (variation in weight loss, different starting BPs, uncontrolled adjustments in BP medications), it is nearly impossible to discern just how much the true improvement in BP is attributable to the semaglutide alone. Adding to this is that BP in these trials was not taken in the usual precise ways that is done in trials performed purely for hypertension management—adding further imprecision.
But, the bottom line is irrefutable – semaglutide lowers BP in just about all comers by about 5 mm Hg when compared to placebo in a “real-world” environment where BP is taken per office routine, and BP medications are adjusted per the patient’s provider’s usual standards. Even this relatively small drop in BP—that of about a half medication—can result in considerable overall improvement in cardiovascular risk.
Clinical Topics: Hypertension, Prevention
Keywords: Antihypertensive Agents, Anti-Obesity Agents, Blood Pressure, Glucagon-Like Peptide-1 Receptor, Weight Loss
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