Can you take Wegovy with high blood pressure?

Jump to: Are there any risks associated with taking Wegovy if you have high blood pressure? | Can you take Wegovy with blood pressure medications? | How can Wegovy lower blood pressure? | How to monitor your blood pressure while taking Wegovy | Comparison with other weight-loss medications | Frequently asked questions | Take home message

You can take Wegovy if you’re currently living with high blood pressure and obesity. Research shows that semaglutide (the drug in Wegovy) significantly reduces systolic blood pressure by around 5 mmHg and diastolic blood pressure by around 2.5 mmHg on average¹.

In a 2024 individual patient data meta-analysis of the STEP trials, the difference in systolic blood pressure between semaglutide and placebo groups was approximately 5 mmHg after 68 weeks of treatment². Participants with hypertension showed similar blood pressure reductions to those with normal baseline readings.

To put this in perspective, a 5 mmHg reduction in systolic blood pressure is associated with a 10% lower risk of heart attack, stroke, and other major cardiovascular events³. Participants with hypertension showed similar blood pressure reductions to those with normal baseline readings.

In July 2024, the MHRA granted semaglutide (Wegovy) a new indication specifically for cardiovascular prevention, making it the first weight loss medication in the UK licensed to reduce the risk of heart attacks, strokes, and cardiovascular death in people with established heart disease⁴. This approval was based on the SELECT trial, which demonstrated a 20% reduction in major cardiovascular events compared to placebo.

This means Wegovy isn’t just a weight loss medication that happens to improve heart health; it’s now officially recognised as a cardiovascular protective treatment in its own right.

It’s important to note that these clinical trials had specific eligibility criteria, and results may differ based on your personal health circumstances.

If you don’t have a higher BMI but have high blood pressure, you won’t be prescribed Wegovy, as it could lead to excessive weight loss that may prevent you from maintaining a healthy weight.

In this scenario, you may need to naturally lower your blood pressure or speak with your doctor about other options.

Key blood pressure findings from clinical research:

• Average systolic reduction: approximately 5 mmHg¹
• Average diastolic reduction: approximately 2.5 mmHg¹
• Blood pressure reduction was consistent across both normotensive and hypertensive participants²
• Participants on semaglutide were more likely to reduce their blood pressure medications²
• The SELECT trial showed a 3.3 mmHg reduction in systolic blood pressure alongside cardiovascular benefits⁴

Are there any risks associated with taking Wegovy if you have high blood pressure?

While Wegovy generally shows positive effects on blood pressure, it’s important to understand the potential risks and side effects that may affect people with hypertension^1,2.

The most common side effects of Wegovy are gastrointestinal, including nausea, vomiting, and diarrhoea. These are usually mild to moderate and tend to decrease over time.

For people with high blood pressure, specific considerations include:

• Dizziness, particularly during the initial weeks of treatment or dose increases
• Potential for low blood pressure if you’re already taking multiple blood pressure medications
• Dehydration from gastrointestinal side effects, which can affect blood pressure

The Medicines and Healthcare products Regulatory Agency (MHRA) advises that patients with the following conditions should exercise additional caution when considering Wegovy⁵:

• Severe or unstable hypertension
• History of significant orthostatic hypotension (blood pressure drop when standing)
• Recent cardiovascular events (within 6 months)
• Multiple blood pressure medications, particularly if recently adjusted

While serious adverse events related to blood pressure are rare, initial clinical trials excluded people with uncontrolled hypertension (>160/100 mmHg).

If your blood pressure is above this threshold, your healthcare provider may recommend better controlling your blood pressure before starting Wegovy¹.

Research from the STEP trials suggests that most people on Wegovy with high blood pressure will experience no adverse events from the medication, and any adverse events are likely to be mild and temporary.

Can you take Wegovy with blood pressure medications?

You can take Wegovy with blood pressure medications³.

However, it’s recommended that you monitor your blood pressure closely, as the combination of Wegovy with other blood pressure-lowering medications may increase the risk of adverse events like hypotension and dizziness.

Your doctor will likely monitor your response to Wegovy alongside blood pressure medications more carefully than patients without hypertension.

Interestingly, research from the STEP trials showed that participants taking semaglutide were more likely to have their blood pressure medications reduced compared to those on placebo². This suggests that as Wegovy helps lower your blood pressure, you may need less medication over time.

If your blood pressure starts to decline in response to the treatment, your doctor may lower your blood pressure medication dose to avoid adverse events⁵. In practice, this means:

• Having more frequent blood pressure checks in the first 3 months
• Possibly monitoring your blood pressure at home
• Reporting any dizziness or lightheadedness promptly to your doctor
• Being prepared for potential adjustments to your existing medications

Never adjust your blood pressure medications yourself without consulting your healthcare provider.

How can Wegovy lower blood pressure?

The exact mechanisms by which Wegovy lowers blood pressure aren’t fully understood. However, we have a good understanding of the likely pathways involved.

It’s well known that obesity and obesity-related conditions like type 2 diabetes significantly increase the risk of developing high blood pressure (hypertension).

The causes and factors influencing blood pressure are complex. Still, one problem observed in people with high blood pressure is that their kidneys seem to hold onto more sodium, which can lead to the body retaining excess water, increasing blood pressure over time⁶.

Another issue is vasoconstriction, where your blood vessels ‘tighten’ or ‘stiffen’, making it difficult for blood to flow through your system. To counter this effect, your heart has to pump harder (increasing blood pressure).

So, if we can improve our kidneys’ ability to excrete excess sodium, manage fluid balance, and reduce vessel stiffening, we’ll likely see improvements in blood pressure.

Research has shown that high insulin levels (insulin resistance) can also cause the kidneys to hold onto more sodium and increase blood pressure⁷.

So, one possible way that Wegovy may lower blood pressure is by reducing insulin levels and insulin resistance, which helps the body excrete more sodium from the kidneys, thereby lowering blood pressure over time.

Wegovy works by mimicking GLP-1, a hormone that regulates appetite and blood sugar. GLP-1 receptors are found throughout the body, including in blood vessels and the kidneys, which may explain some of the direct effects on blood pressure beyond weight loss⁶.

Interestingly, analysis from the STEP trials suggests that while weight loss plays a significant role in blood pressure reduction, some of the effect may be independent of weight loss². This aligns with what we know about GLP-1’s direct effects on the cardiovascular system.

Read our guide on how to lower blood pressure to understand blood pressure and how to treat it in more detail.

How to monitor your blood pressure while taking Wegovy

If you have high blood pressure and are starting Wegovy, regular monitoring becomes particularly important. Research shows that blood pressure changes can occur within the first few weeks of treatment^1,2.

The National Institute for Health and Care Excellence (NICE) recommends the following monitoring approach for patients with hypertension who are starting weight-loss medications³:

• Establish a baseline blood pressure reading before starting treatment
• Check blood pressure at each dose escalation appointment
• Once on a stable dose, monitor blood pressure at least monthly for the first three months
• After three months, continue monitoring according to your usual hypertension care plan

Many patients find home blood pressure monitoring helpful. If you choose this approach:

• Use a validated upper arm cuff monitor (wrist monitors are generally less accurate)
• Take readings at the same time each day, ideally in the morning
• Take 2-3 readings each time and record the average
• Bring your readings to appointments with your healthcare provider
• Alert your healthcare team if you notice significant changes (>20 mmHg systolic or >10 mmHg diastolic)

It’s important to note that as your blood pressure improves, you may need adjustments to your existing blood pressure medications. Never adjust these medications yourself and always consult with your healthcare provider.

How Wegovy compares to other medications for blood pressure effects

Understanding how Wegovy’s effects on blood pressure compare to other weight-loss medications can help you have informed discussions with your healthcare provider. The table below summarises current evidence^1,2,4,8.

The data suggest that Wegovy provides blood pressure benefits comparable to lifestyle interventions, while also supporting significant weight loss and cardiovascular risk reduction.

However, it’s important to remember that Wegovy is not approved specifically for blood pressure treatment, and these effects should be considered a beneficial secondary outcome rather than the primary treatment goal³.

The SELECT trial, which studied over 17,600 participants with cardiovascular disease and obesity, showed that semaglutide reduced the risk of major cardiovascular events by 20% compared to placebo⁴. This makes Wegovy particularly relevant for people with both obesity and cardiovascular risk factors like high blood pressure.

Frequently asked questions

Will Wegovy interact with my blood pressure medications?

Wegovy doesn’t have direct drug interactions with common blood pressure medications. However, as Wegovy may lower your blood pressure, the combined effect with your existing medications could potentially cause it to drop too low.

Your doctor may need to adjust your blood pressure medication dosage as you lose weight and your blood pressure improves⁵.

How quickly will Wegovy affect my blood pressure?

Clinical studies suggest blood pressure improvements can begin within weeks of starting treatment, with effects continuing to develop over 3-6 months.

The blood pressure reduction appears to be related to both weight loss and direct effects of semaglutide on the cardiovascular system^2,6.

Should I stop my blood pressure medications when starting Wegovy?

No. Never discontinue prescribed medications without consulting your healthcare provider. Your doctor will monitor your blood pressure and adjust your medications as needed based on your response to treatment.

Is the blood pressure-lowering effect of Wegovy permanent?

The blood pressure benefits appear to be maintained as long as you continue taking Wegovy and maintain healthy habits.

Research from the STEP 1 trial extension showed that blood pressure improvements partially reversed after stopping semaglutide, alongside some weight regain⁹. This highlights the importance of developing sustainable lifestyle habits while on treatment.

Does Mounjaro work better for blood pressure than Wegovy?

Some comparative data suggest that tirzepatide (Mounjaro) may have a stronger effect on blood pressure than semaglutide (Wegovy). This might be due to Mounjaro’s dual action on both GLP-1 and GIP receptors.

However, Wegovy has the advantage of proven cardiovascular benefits from the SELECT trial. Individual responses vary, and what works best depends on your specific situation^4,8.

Can Wegovy cause dangerously low blood pressure?

While rare, significant hypotension (low blood pressure) can occur, especially in people already taking multiple blood pressure medications.

Signs of low blood pressure include dizziness, lightheadedness, fainting, or unusual fatigue. Contact your healthcare provider immediately if you experience these symptoms⁵.

Is it safe to exercise while taking Wegovy if I have high blood pressure?

Exercise is generally beneficial for both weight loss and blood pressure control. However, if you’ve recently started Wegovy and have a history of hypertension, begin with moderate activity and monitor how you feel.

Some people experience dizziness during the initial weeks of treatment, so it’s wise to avoid high-intensity exercise until you understand how your body responds³.

Do I need more frequent blood pressure monitoring on Wegovy?

If you have hypertension and start Wegovy, more frequent monitoring is recommended, especially during the first three months and during dose adjustments. Home blood pressure monitoring can be valuable in tracking your response to treatment³.

Take home message

Wegovy can be an effective option for people living with both obesity and high blood pressure, with clinical evidence showing significant reductions in blood pressure alongside weight loss and cardiovascular benefits^1,2,4.

The key points to remember are:

• Wegovy typically reduces systolic blood pressure by around 5 mmHg and diastolic blood pressure by 2-2.5 mmHg in clinical trials
• Regular blood pressure monitoring is essential, especially during the first three months
• Work closely with your healthcare provider to adjust any existing blood pressure medications as needed
• Wegovy has proven cardiovascular benefits, reducing the risk of major cardiovascular events by 20% in the SELECT trial
• The blood pressure benefits appear to persist as long as treatment continues

If you’re living with obesity and hypertension, a comprehensive approach that includes appropriate medication, dietary changes, regular physical activity, and stress management offers the best chance for long-term health improvements.

References

1. Kennedy, C., et al. (2023). The Effect of Semaglutide on Blood Pressure in Patients without Diabetes: A Systematic Review and Meta-Analysis. Journal of Clinical Medicine, 12(3), 772.
2. Kennedy, C., et al. (2024). Semaglutide and blood pressure: an individual patient data meta-analysis. European Heart Journal, 45(38), 4124-4134.
3. National Institute for Health and Care Excellence. (2023). Semaglutide for managing overweight and obesity (TA875).
4. Lincoff, A.M., et al. (2023). Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes. New England Journal of Medicine, 389(24), 2221-2232.
5. Medicines and Healthcare products Regulatory Agency. (2024). Drug Safety Update: GLP-1 receptor agonists.
6. Bain, S., et al. (2018). Reduction in systolic blood pressure with semaglutide treatment is not due to weight loss alone: data from SUSTAIN 1-5. European Heart Journal, 39(suppl_1).
7. Reaven, G.M., et al. (1997). Renal effects of insulin in man. Journal of Nephrology, 10(4), 188-91.
8. Lingvay, I., et al. (2023). Systolic blood pressure reduction with tirzepatide in patients with type 2 diabetes: insights from SURPASS clinical program. Cardiovascular Diabetology, 22(1), 66.
9. Wilding, J.P.H., et al. (2022). Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. Diabetes, Obesity and Metabolism, 24(8), 1553-1564.