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.
Weight loss also significantly improves the body’s response to insulin, says Sarah Ackah, MD, an endocrinologist at the Ohio State University Wexner Medical Center in Columbus. When insulin doesn’t work properly, blood sugar rises, blood vessels become damaged, and blood pressure becomes harder to control.
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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.
Additionally, weight loss can improve or even resolve conditions that worsen hypertension, such as sleep apnea and chronic joint pain that limits physical activity, says Bahrainwala. When people become more mobile and metabolically healthier, blood pressure often improves as well.
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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.
