Obesity With Hypertension: Can GLP-1s Help?

Obesity and high blood pressure (hypertension) often go hand in hand, and together, they significantly raise the risk of heart disease, stroke, and kidney damage. While lifestyle changes and blood pressure medications remain the foundation of hypertension treatment, the popular weight loss drugs known as GLP-1s are making an impact on how hypertension is managed.

Originally developed to treat type 2 diabetes, GLP-1 medications are now widely prescribed for weight loss. Helping people shed extra pounds and achieve a healthy weight improves a host of other conditions and symptoms, including high blood pressure. These medications also appear to lower blood pressure through mechanisms that are separate from weight loss.

Excess weight affects blood pressure in multiple, overlapping ways, which is why hypertension is so common in people with obesity.

“Obesity has multiple harmful effects on the body,” says Jehan Bahrainwala, MD, a nephrologist and certified hypertension specialist at the Stanford Hypertension Center in California. It plays a major role in the development and progression of many chronic conditions, including heart disease, kidney disease, sleep apnea, and diabetes, all of which can worsen blood pressure control, she says.

GLP-1 drugs are not specifically approved to treat hypertension, but data from large clinical trials shows that these drugs lower blood pressure modestly but consistently. The effect varies by medication, dose, and whether the drug is used for diabetes or obesity, but the overall pattern is clear.

Here’s how much the most popular GLP-1 drugs prescribed for weight loss can lower blood pressure:

• Semaglutide (Wegovy) At the highest prescribed dose of 2.4 milligrams (mg), semaglutide lowers systolic blood pressure (the top number) an average of 4.8 mmHg and lowers diastolic blood pressure (the bottom number) an average of 2.45 mmHg.

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• Tirzepatide (Zepbound) At the highest recommended dose of 15 mg, Tirzepatide lowers systolic blood pressure by about 6.8 mmHg and diastolic about 4.2 mmHg.

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• Liraglutide (Saxenda) At the highest recommended dose of 3 mg, Liraglutide lowers blood pressure an average of 3.2 mmHg, with no apparent effect on diastolic blood pressure.

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For most people, the blood pressure benefits of GLP-1 drugs come primarily from weight loss itself. In general, larger weight losses lead to larger drops in blood pressure, particularly at higher doses, says Dr. Bahrainwala.

In addition to improving insulin sensitivity and lowering blood sugar, losing weight also reduces inflammation throughout the body, all of which adds up to less strain on the cardiovascular system, says Dr. Ackah.

In practice, the changes in blood pressure can be significant. Bahrainwala has seen patients who lost substantial weight on GLP-1 therapy and needed their blood pressure medications reduced or stopped altogether.

“I’ve had to work actively with these patients to cut back their blood pressure medications because of the improvements caused by the GLP-1 weight loss,” she says.

There’s growing evidence that GLP-1 drugs may improve blood pressure through mechanisms that go beyond weight loss, but researchers are still trying to tease out the details.

“The reduction in blood pressure happens earlier than we expect if it was all due to weight loss,” says Luke Laffin MD, co-director of the Blood Pressure Disorders Center at Cleveland Clinic in Ohio.

There are several possible explanations, says Laffin.

• Reduced Inflammation GLP-1 receptors exist in the heart and blood vessels themselves. When these receptors are activated, the heart muscle can use energy more efficiently, which leads to less stress and inflammation. That matters because chronic inflammation can damage blood vessels and contribute to high blood pressure.

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• Relaxation of Blood Vessels GLP-1s help the body manage glucose more smoothly after meals by increasing insulin and lowering glucagon, which reduces the damage that high blood sugar can cause to blood vessels over time.

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• Nervous System Regulation and Reduced Stress Hormones
There’s evidence that GLP-1 drugs may reduce overactivation of the sympathetic nervous system, which controls the body’s fight-or-flight response. When this system is less active, heart rate and blood pressure may decrease, even without significant weight changes.
• Increased Sodium Excretion and Kidney Effects.
GLP-1s help the kidneys release more sodium into the urine, which reduces fluid buildup in the bloodstream and eases pressure on blood vessels. This may contribute to blood pressure improvements alongside weight loss but is not entirely because of it.

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For now, experts agree that any direct effect on blood pressure is likely secondary to and smaller than the impact of weight loss itself. “We know that the more weight loss achieved with a GLP-1 often results in more blood pressure reduction,” says Laffin.

GLP-1 medications aren’t classified as blood pressure drugs, but they can be powerful tools for people whose hypertension is closely tied to excess weight.

If you’re interested in trying GLP-1 medications, talk to your doctor about which one may be best for you. Although some medications may show bigger reductions in weight or blood pressure in clinical trials, that doesn’t mean it’s automatically better for you. The drop in blood pressure from a GLP-1 is influenced by multiple factors depending on the individual, says Bahrainwala.

If you’re under a doctor’s care for high blood pressure, never reduce your dose of blood pressure medication or stop taking it without having a discussion with your healthcare provider first.

• Obesity and high blood pressure are closely connected. GLP-1 weight loss drugs are showing promise as a useful tool for people whose hypertension is driven by excess weight.
• Research suggests that GLP-1 drugs lower blood pressure modestly but consistently. This happens primarily because of the weight loss spurred by these popular medications.
• Individual results vary on these medications, and they should never replace any blood pressure medications you’ve been prescribed.