From the Guidelines
Semaglutide does not cause hypertension; in fact, it typically has the opposite effect, as evidenced by the most recent and highest quality study, which demonstrated a reduction in cardiovascular events and blood pressure in patients with type 2 diabetes 1.
Key Findings
- Semaglutide, a GLP-1 receptor agonist, has been shown to modestly reduce blood pressure in most patients, with average systolic blood pressure reductions of 2-6 mmHg with semaglutide treatment.
- The blood pressure-lowering effect of semaglutide is believed to result from several mechanisms, including weight loss, improved insulin sensitivity, direct vascular effects, and enhanced sodium excretion by the kidneys.
- Clinical trials, such as the STEP trials, have demonstrated the efficacy of semaglutide in reducing weight and improving weight-related comorbidities, including a lower risk of cardiovascular events 1.
Clinical Implications
- Patients should be aware that when starting semaglutide, some may experience dehydration due to its gastrointestinal side effects like nausea, vomiting, or diarrhea, which could temporarily affect blood pressure.
- If semaglutide is used alongside antihypertensive medications, healthcare providers may need to monitor and adjust these medications to prevent hypotension.
- Regular blood pressure monitoring is recommended when initiating semaglutide treatment, especially in patients with pre-existing cardiovascular conditions.
Evidence Summary
- The most recent and highest quality study, published in 2023, demonstrated that semaglutide reduces the risk of cardiovascular events and blood pressure in patients with type 2 diabetes 1.
- A meta-analysis of GLP-1 receptor agonists, including semaglutide, reported a significant reduction in cardiovascular events and blood pressure in adults with overweight or obesity without diabetes 1.
From the Research
Semaglutide and Hypertension
- Semaglutide has been shown to have a blood pressure lowering effect in patients with type-2 diabetes, with a weighted mean difference in systolic blood pressure of -2.31 mmHg compared to placebo or other antihyperglycemic agents 2.
- The reduction in systolic blood pressure was similar for subcutaneous and oral administration of semaglutide, with -2.36 mmHg and -2.50 mmHg, respectively 2.
- GLP-1 receptor agonists, including semaglutide, have been found to have beneficial effects on cardiovascular risk factors, including blood pressure, in patients with type 2 diabetes 3, 4.
- In patients without diabetes, semaglutide has been shown to reduce blood pressure, with a mean difference in systolic blood pressure of -4.83 mmHg and diastolic blood pressure of -2.45 mmHg compared to placebo 5.
- A study in patients with preexisting cardiovascular disease and overweight or obesity but without diabetes found that semaglutide reduced the incidence of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke compared to placebo 6.
Mechanisms and Effects
- The mechanisms by which semaglutide produces its cardiovascular benefits are not fully understood, but may include improvements in endothelial function, coronary ischemia, and heart failure 3, 4.
- Semaglutide has been found to lower plasma lipid levels and reduce blood pressure, both of which contribute to a reduction in atherosclerosis and cardiovascular disease 4.
- The GLP-1 receptor is expressed in multiple cardiovascular cell types, and semaglutide may exert its effects through signaling in these cells 4.