From the Guidelines
Tirzepatide can be taken with a history of CVA, hypertension, and diverticulitis, but careful consideration and monitoring by a healthcare provider are necessary. Tirzepatide is a dual-hormone agonistic medication, acting on both the GLP-1 receptor and the glucose-dependent insulinotropic polypeptide receptor, used for type 2 diabetes management and weight loss 1. For patients with a history of stroke (CVA), tirzepatide does not appear to increase stroke risk and may help manage risk factors like blood glucose and weight. The evidence from studies on GLP-1 agonists, which have a similar mechanism of action to tirzepatide, suggests a potential reduction in stroke risk compared to usual care 1.
For hypertension, tirzepatide typically does not raise blood pressure and might even provide modest blood pressure reductions, as seen with other GLP-1 agonists 1. Regarding diverticulitis, there is no direct contraindication for tirzepatide, though gastrointestinal side effects like nausea, vomiting, or diarrhea are common and should be monitored 1.
The medication is typically started at a low dose (2.5mg weekly) and gradually increased to minimize side effects. Staying well-hydrated and maintaining regular medical follow-ups is crucial, especially for blood pressure monitoring and any digestive symptoms. The healthcare provider may need to adjust other medications being taken for these conditions when starting tirzepatide. Given the most recent evidence, tirzepatide's benefits in managing diabetes and weight, potentially reducing cardiovascular risk, and its tolerability profile, make it a viable option for patients with a history of CVA, hypertension, and diverticulitis, under close medical supervision 1.
From the Research
Tirzepatide and Cardiovascular History
- Tirzepatide has been studied in patients with type 2 diabetes and increased cardiovascular risk 2, 3.
- In the SURPASS-4 trial, tirzepatide demonstrated greater HbA1c reduction and lower incidence of hypoglycaemia compared to insulin glargine, with no increase in major adverse cardiovascular events (MACE) 2.
- The SURPASS-3 trial also showed that tirzepatide was superior to insulin degludec in reducing HbA1c and bodyweight, with a lower risk of hypoglycaemia 3.
Tirzepatide and Diverticulitis
- There is no direct evidence on the use of tirzepatide in patients with a history of diverticulitis.
- However, a study found that a history of diverticulitis may be an independent risk factor for incident cardiovascular disease, suggesting possible common etiopathogenic mechanisms 4.
Cardiovascular Risk and Antidiabetic Drugs
- Non-insulin antidiabetic drugs have varying effects on cardiovascular risk, with metformin and SGLT-2 inhibitors showing proven cardiovascular benefits 5.
- GLP-1 analogues, such as tirzepatide, have also been shown to offer significant cardiovascular benefits and are recommended for patients with overt cardiovascular disease 5.
Hypertension and Tirzepatide
- There is no specific information on the use of tirzepatide in patients with hypertension.
- However, the SURPASS-4 trial included patients with established cardiovascular disease or high risk of cardiovascular events, which may have included patients with hypertension 2.
CVA and Tirzepatide
- There is no specific information on the use of tirzepatide in patients with a history of cerebrovascular accident (CVA).
- However, the SURPASS-4 trial included patients with established cardiovascular disease, which may have included patients with a history of CVA 2.