Unexpected blood pressure drop with Semaglutide

[Michael D]

I have always had high blood pressure, even as a child. Since my BP spikes up and down, seemingly randomly, it's very difficult to control. And in the past few years the highs have been 200+/100+, high enough for one doctor to refuse to treat me anymore, and another doc wanted me to go the ER. Long story short, my kidney function has been compromised, so when I saw a study that stated semaglutide could improve kidney function, I decided to try it when Precision Peptides announced they were selling it on this website. I started with a very low dose (.25 mg/week) and slowly increased to .75mg/week. Even with a suite of BP meds, my BP was often still in the 160s/90s. But very slowly my BP began to go down. For the past month or so I've been solidly in the 120s/70s. The only difference in my medication/supplement/diet has been the peptide. Not only that, my prediabetic blood sugar levels dropped into the normal range, my kidney function improved, and I lost 10 lbs (5'10", from 182 to 172 lbs).

Today I came clean with my cardiologist. He was a bit astounded. He told me that he cannont recommend I keep taking semaglutide, but he also said he wouldn't tell me to stop. He even went so far as to ask me to see if my GP could write me a prescription for it to legitimize my use of the peptide.

I'm very curious if other people have tried semaglutide and subsequently noticed a BP drop? There is some hints of this in the medical journals, but no serious study has been published.

 

[Nelson Vergel]

Weight loss and better glucose control can decrease blood pressure.

Semaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1 RA), has been shown to have a significant effect on blood pressure, particularly in patients with type 2 diabetes (T2D). The following summarizes the findings from various studies and reviews on this topic:

Blood Pressure Reduction in Type 2 Diabetes Patients​

1. Systematic Review and Meta-Analysis:
   • A systematic review and meta-analysis of 29 randomized controlled trials (RCTs) involving 26,985 participants found that semaglutide significantly reduced systolic blood pressure (SBP) by an average of 2.31 mmHg compared to placebo or other antihyperglycemic agents (AHAs). The effect on diastolic blood pressure (DBP) was minimal, with a change of 0.09 mmHg.
   • The reduction in SBP was consistent across both oral and subcutaneous formulations of semaglutide.
2. Clinical Trials and Observational Studies:
   • The SUSTAIN trials reported a decrease in SBP ranging from 2.6 to 5.1 mmHg with semaglutide 0.5 mg and 2.7 to 7.3 mmHg with semaglutide 1.0 mg, compared to a decrease of 1.0 to 2.3 mmHg with comparators.
   • Another study indicated that semaglutide reduced SBP by 3.4 mmHg and 5.4 mmHg for doses of 0.5 mg and 1.0 mg, respectively, over 104 weeks.

Blood Pressure Reduction in Non-Diabetic Populations​

1. Normotensive Populations with Obesity:
   • In normotensive individuals with obesity, semaglutide was associated with a reduction in SBP by approximately 5 mmHg and in DBP by 2.5 mmHg.
   • The STEP trials showed that semaglutide led to significant reductions in both SBP and DBP, with a notable decrease in antihypertensive medication use among participants.

Mechanisms of Action​

1. Weight Loss and Appetite Regulation:
   • Semaglutide promotes weight loss by suppressing gastric peristalsis, inhibiting appetite, and slowing gastric emptying, which indirectly contributes to blood pressure reduction.
   • The weight loss achieved with semaglutide is a significant factor in its ability to lower blood pressure, although other mechanisms independent of weight loss may also play a role.
2. Direct Cardiovascular Effects:
   • Semaglutide's activation of GLP-1 receptors in various organs involved in blood pressure regulation, such as the kidneys and the brainstem, contributes to its antihypertensive effects.

Clinical Implications​

1. Cardiovascular Benefits:
   • Beyond blood pressure reduction, semaglutide has been shown to improve other cardiometabolic risk factors, including glycated hemoglobin (HbA1c), body weight, and lipid profiles, which collectively reduce cardiovascular risk.
   • The SELECT trial demonstrated that semaglutide significantly reduced the risk of major cardiovascular events, including heart attack, stroke, and cardiovascular death, in individuals with obesity and cardiovascular conditions but without diabetes.
2. Safety and Tolerability:
   • Semaglutide has a safety profile similar to other GLP-1 RAs, with common side effects being gastrointestinal in nature. It does not significantly increase the risk of hypoglycemia.

In summary, semaglutide effectively lowers systolic blood pressure in patients with type 2 diabetes and in normotensive individuals with obesity. Its benefits extend beyond blood pressure control to include significant weight loss and improvements in various cardiometabolic parameters, making it a valuable therapeutic option for managing both diabetes and obesity-related hypertension.


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[Michael D]

Great reference, Nelson. In my case, I'm not (and wasn't) obese...not really even overweight. And my blood sugar levels were pre-diabetic and not treated. So I fall a bit outside of this study. It would be great to hear from others to know if I'm just an outlier.

 

[Nelson Vergel]

I just found this reference:

https://www.ahajournals.org/doi/10.1161/JAHA.118.010321?t