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REFLECTIONS
Hypertension
Hypertension Global Newsletter #7 2024

The authors conclude that the use of a low-dose combination pill
as the initial strategy to treat hypertension may be an important CLICK HERE Hypertension
strategy to reduce therapeutic inertia episodes and achieve FOR THE LINK TO FULL ARTICLE
better blood pressure control. Further education is needed about
the importance of treatment intensification despite a significant
improvement in BP or BP being close to target.

Semaglutide and blood pressure: An individual patient data meta-analysis.

Kennedy C, et al. Eur Heart J. 2024 Sep 1:ehae564. doi: 10.1093/eurheartj/ehae564. Online ahead of print.

Semaglutide, a GLP-1 RA, is an effective obesity treatment, resulting in >10% weight loss. In previous clinical trials, it has also
been reported to reduce SBP in normotensive patients. Given that the interaction of obesity with hypertension is multifaceted,
targeting the disease of obesity may be an effective strategy to control BP, particularly for patients suffering from resistant
hypertension (RH).

This individual patient data meta-analysis aimed to determine the effect of semaglutide treatment on SBP in patients with
hypertension, SBP in patients with RH, SBP when baseline BMI is considered, and any alterations to antihypertensive
medications.

This study included 3136 participants without diabetes from three RCTs: 2109 in the treated group and 1027 in the placebo
group. In the semaglutide and placebo groups, 36.6% and 36% of patients, respectively, were diagnosed with HTN, while
43.4% and 44.4% were treated for hypertension. Patients were categorised into four categories based on diagnosis,
medications, and baseline BP (as seen in the graphical abstract).

The primary outcome was the mean difference in SBP change from baseline to trial conclusion (over 68 weeks), while the
secondary outcome was a change in antihypertensive treatment. Analyses were performed for the complete cohort and
prespecified categories (see graphical abstract below).

The difference in SBP change between the treatment and placebo groups was −4.95 mmHg [95% CI −5.86 to −4.05]. This
difference was −4.78 mmHg (95% CI −5.97 to −3.59) for hypertension diagnosis, −4.93 mmHg (95% CI −6.75 to −3.11) for
baseline SBP >130 mmHg, −4.09 mmHg (95% CI −7.12 to −1.06) for baseline SBP >140 mmHg, and −3.16 mmHg (95% CI
−8.69 to –2.37) for apparent resistant hypertension. Reduction in SBP was mediated substantially by weight loss.

The antihypertensive treatment intensity score decreased for those on semaglutide compared to placebo (−0.51; 95% CI
−0.71 to −0.32). The effect was most pronounced in patients with RH, as 26.9% of those treated with semaglutide had their
antihypertensives de-escalated compared to 3% of those on placebo (OR 6.68; 95% CI 1.77–43.93, p=.015).

Including the change in body weight in the analysis negated semaglutide’s BP effect, suggesting that the effect is at least partly
mediated by weight loss. Both SBP and weight reduction were consistent across hypertension categories.

The authors noted that a more significant treatment effect for patients with hypertension may be masked by alterations to their
antihypertensive regimens during the trial. This finding may in part be due to concurrent reductions to antihypertensive medications.

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