How does Ozempic affect blood pressure?

Ozempic (semaglutide) is more likely to lower blood pressure than to increase it and several trials of semaglutide have shown significant reductions in blood pressure in people who had normal blood pressure to start with, or slightly elevated blood pressure to start with. There is a lack of studies on people with high baseline blood pressure, but it seems likely that their blood pressure would also decrease with Ozempic.

Blood pressure reduction does seem to correlate with weight loss; however, there also seem to be some other, as yet unknown, non-weight loss mechanisms also contributing to the weight loss.

Older adults may be more susceptible to these blood pressure decreases because they are more susceptible to orthostatic hypotension – that is the sudden drop in blood pressure when standing up from sitting or lying down

Summary of Research

Across the Sustain 1-5 trials (n=3,918), greater reductions in systolic BP were related to greater weight loss. However, it also appeared that other, unknown weight loss mechanisms were also contributing to weight loss.

• An average decrease in SBP of 2.6 to 5.1 mmHg and 2.7 to 7.3 mmHg with semaglutide 0.5 and 1.0 mg, respectively, vs −1.0 to −2.3 mmHg with comparators was reported in participants who had a baseline BP or 128.8–134.8 mmHg).
• In the >4.0 kg WL category, the mean change in SBP was −3.0 to −6.8 and −4.4 to −9.3 mmHg with semaglutide 0.5 and 1.0 mg, respectively, vs −4.0 to +1.1 mmHg with comparators.
• In the 0–4.0 kg WL category, the mean change in SBP was −2.0 to −4.8 mmHg and −0.7 to −5.2 mmHg with semaglutide 0.5 and 1.0 mg, respectively, vs -2.1 to -4.2 mmHg with comparators.
• For subjects with no WL/BW gain, the mean change in SBP was −1.5 to +1.5 mmHg and −5.4 to +1.0 mmHg with semaglutide 0.5 and 1.0 mg, respectively, vs −1.0 to +1.1 mmHg with comparators.

An overall decrease in blood pressure was reported in a review of 6 high-quality RCTS (n=4744) that compared semaglutide to a placebo (an inactive treatment) (Kennedy, 2023). The mean BP before initiation of semaglutide was in the normotensive range (usually quoted as 115-120/70-75 mmHg), and most participants were female and white. Studies ranged in length from 48 to 104 weeks.

• The mean difference in systolic BP was −4.83 mmHg (95% CI: −5.65 to −4.02)
• The mean difference in diastolic BP was −2.45 mmHg (95% CI: −3.65 to −1.24).
• The study concluded that a significant reduction in blood pressure was evident following semaglutide treatment in normotensive populations without diabetes. This study did not report on the effects semaglutide had on BP in those with high blood pressure to start with.

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