Semaglutide and blood pressure: an individual patient data meta-analysis

Background and Aims Randomized clinical trials (RCTs) assessing semaglutide reported reductions of systolic blood pressure (SBP) in trial populations with baseline blood pressure in the normotensive range. This study aimed to determine whether this SBP reduction is greater in hypertensive groups.

Methods Individual patient data (IPD) from three RCTs examining the effect of semaglutide 2.4 mg on body weight over 68 weeks were included. Trial participants were categorized according to a hypertension diagnosis, treatment or baseline measurement (HTN), baseline SBP > 130 mmHg (HTN130) or >140 mmHg (HTN140), and those with apparent resistant hypertension (RH). The primary analysis compared the in-trial change in SBP in the semaglutide and placebo arms. Alterations of anti-hypertensive medications were quantified by treatment intensity score and compared between arms. These analyses were performed using analysis of covariance.

Results Overall, 3136 participants were included. The difference in SBP change between the treatment (n = 2109) and placebo (n = 1027) groups was −4.95 mmHg [95% confidence interval (CI) −5.86 to −4.05] overall. This difference was −4.78 mmHg (95% CI −5.97 to −3.59) for HTN, −4.93 mmHg (95% CI −6.75 to −3.11) for HTN130, −4.09 mmHg (95% CI −7.12 to −1.06) for HTN140, and −3.16 mmHg (95% CI −8.69–2.37) for RH. Reduction in SBP was mediated substantially by weight loss. The anti-hypertensive treatment intensity score decreased for those on semaglutide compared to placebo (−0.51; 95% CI −0.71 to −0.32).

Conclusions This IPD analysis of three large RCTs found blood pressure reductions with semaglutide in participants with hypertension that were similar to those seen in all trial participants. This finding may in part be due to concurrent reductions to antihypertensive medications. These results suggest that semaglutide is a useful adjunctive treatment for patients with hypertension and obesity.