Dr. Ahmed
Does Mounjaro Lower Blood Pressure?
People starting Mounjaro or those already using it may ask this question for the following reasons:
- Hypertension is a very common comorbid condition with diabetes. Most diabetics are also on blood pressure-lowering medications. People on Mounjaro are concerned about its effects on their blood pressure as well.
- Mounjaro can cause hypoglycemia when co-administered with insulin or other diabetes medications. The symptoms of hypoglycemia are sometimes confused with that of low blood pressure.
- Mounjaro significantly lowers your body weight. Weight loss is associated with an improvement in blood pressure. But does Mounjaro lower blood pressure in clinical trials? is there any evidence?
Here is an insight from the SURPASS clinical trial.
Key points:
- Systolic blood pressure (SBP) significantly decreased with Tirzepatide, a once-weekly therapy for type 2 diabetes, in all SURPASS-1 to -5 clinical trials.
- The degree of SBP reduction varied according to Tirzepatide dosage; after the 40-week study period, the 15 mg dosage had the greatest impact on lowering SBP, with readings ranging from −3.1 to −11.5 mmHg.
- Subsequent mediation analyses showed that weight loss was the main mechanism through which the observed SBP reductions were mediated. Still, the contributions from weight-loss-independent effects varied in strength among the trials.
- In the SURPASS-4 study, where patients had cardiovascular disease, a significant part (33% to 57%) of the difference in blood pressure reduction between those taking Tirzepatide and those using insulin glargine was explained by effects unrelated to weight loss.
- Tirzepatide lowered blood pressure independently of baseline use of antihypertensive medications.
- The most significant reductions occurred in individuals with higher initial blood pressure (>140 mmHg), with no additional decrease observed in those with the lowest baseline blood pressure (<122 mmHg).
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Does Mounjaro Lower Blood Pressure?
Type 2 diabetes (T2D) often coexists with hypertension, being twice as prevalent in individuals with T2D compared to those without this condition.
Almost 1.28 billion adults aged 30 to 79 years worldwide have hypertension in 2023 [ref].
Furthermore, there is evidence that hypertension can raise the chance of microvascular and macrovascular complications in diabetic patients, including retinopathy, nephropathy, and atherosclerotic cardiovascular disease.
The American Diabetes Association recommends that T2DM patients target a blood pressure (BP) below 140/90 mmHg, but those at high cardiovascular risk are advised to aim for a BP below 130/80 mmHg [ref].
Conversely, the European Society of Cardiology and the European Association for the Study of Diabetes suggest a BP target range of 120–130/70–80 mmHg [ref].
Tirzepatide, sold under the brand name Mounjaro and Zepbound, is an antidiabetic medication used for type 2 diabetes and weight loss.
This is a once-weekly treatment for type 2 diabetes and is approved in the United States, Europe, and Japan.
In global studies (SURPASS-1 to -5), Tirzepatide significantly lowered glycated hemoglobin A1c (HbA1c), leading to substantial weight loss over 40 to 52 weeks. This helped many people with T2DM achieve better glucose control [ref: 1 and 2].
According to a study published this year, Tirzepatide lowers blood pressure primarily through weight loss, with varying effects across trials.
Importantly, the reduction in blood pressure is not influenced by whether someone is already taking medication for high blood pressure, but it does depend on their starting blood pressure. This helps address worries about potential low blood pressure [ref].
This info is particularly crucial for diabetics who are managing both their blood pressure and blood sugar levels.
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Mounjaro and Hypertension: Study methodology and analysis
This research looked at information from five Tirzepatide clinical trials (SURPASS-1 to -5) for 40/42 weeks.
Two trials used fake pills, while three compared Tirzepatide to different diabetes drugs.
People began with 2.5 mg of Tirzepatide each week and increased by 2.5 mg every 4 weeks, and they could change their high blood pressure medicines during the study.
Weight measurements were done the same way, and a machine checked their blood pressure.
Considering weight loss and other factors, the study checked how Tirzepatide affected blood pressure.
They looked at treatment, weight change, starting blood pressure, use of high blood pressure medicine, country, and blood sugar levels.
Researchers also checked people with or without high blood pressure medicine at the start and how weight change connected with blood pressure. The study included people who took at least one dose, no matter if they followed the instructions.
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Concerns regarding the safety of Tirzepatide
Across SURPASS studies, Tirzepatide was associated with an increase in heart rate of 1-6 beats per minute at the end of study treatment.
In the SURPASS-2 study, Tirzepatide showed higher reductions in HbA1c, weight, and SBP compared to semaglutide by Week 40.
However, there was no significant difference between the two in terms of changes in heart rate from the starting point [ref].
People have suggested different reasons why GLP-1 RAs might increase heart rate, like reflex tachycardia, more activity in the sympathetic nervous system, and direct action on the sino-atrial node. However, none of these reasons have been proven in clinical practice [ref].
Post-hoc analysis of SURPASS-4 data revealed that Tirzepatide significantly reduced the incidence of the composite kidney outcomes compared to insulin glargine, demonstrated clinically meaningful improvement in albuminuria, and slowed the rate of decline in eGFR. These findings may be related to lowering SBP [ref].
So, in conclusion, Tirzepatide is deemed safe for use considering the benefits it has on lowering blood pressure.
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