AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Blood Pressure Effects of Glucagon-Like Peptide-1-Based Therapies: The Untapped Need for Dedicated Hypertension Trials
By Javaid SS, Azam H, Khan LAA et al.
Background: Glucagon-like peptide-1 (GLP-1)-based therapies promote weight loss and improve cardiometabolic outcomes, with modest reductions in blood pressure (BP). However, most evidence regarding their BP effects comes from studies designed primarily to evaluate glycemic control, weight loss, or cardiovascular outcomes, rather than BP as a primary endpoint. Therefore, the true antihypertensive effect of GLP-1-based therapies remains uncertain. Research Question: How rigorously have BP outcomes been assessed and reported in placebo-controlled trials of GLP-1-based therapies? Methods: We systematically reviewed placebo-controlled randomized trials and secondary or post hoc analyses of GLP-1-based therapies published from January 1, 2008, to December 31, 2025. Eligible studies enrolled participants with cardiovascular risk factors or established cardiovascular disease and reported systolic BP (SBP) or diastolic BP (DBP) as a primary, secondary, exploratory, safety, or routine vital assessment outcome. We extracted data on GLP-1 therapy type, BP outcome classification, BP measurement approach, baseline BP, anti-hypertensive therapy reporting, and BP-related findings. Results: A total of 83 studies including 127,101 participants met the inclusion criteria. Hypertension prevalence ranged from 30% to 100%, follow-up duration ranged from 3 to 282 weeks, average baseline SBP ranged from 121.0 to 144.3 mmHg, and average baseline DBP ranged from 72.1 to 85.0 mmHg. The most frequently studied therapies were liraglutide (n=25), semaglutide (n=24), exenatide (n=9), and tirzepatide (n=6). Only 3 studies were designed with SBP as the primary endpoint; all used 24-hour ambulatory BP monitoring (ABPM). Of these, 2 reported significant SBP reductions, whereas none showed a significant change in DBP. The remaining 80 studies assessed BP as a secondary, exploratory, safety, or vital assessment outcome. Among these, 46 reported significant SBP reductions, 21 found no meaningful SBP change, and 13 provided descriptive data only. For DBP, 20 studies reported significant reductions, 5 reported significant increases, 38 found no significant change, and 12 provided descriptive data only. BP measurement protocols were reported in 46 studies, ABPM was used in only 6 studies, and changes in antihypertensive therapy were reported descriptively in only 8 studies. Conclusion: GLP-1-based therapies are associated with modest BP reductions, but most evidence comes from trials in which BP was not the primary endpoint. Inconsistent BP measurement protocols, limited use of ABPM, and poor reporting of changes in anti-hypertension medications further limit interpretation. Future studies should adopt rigorous designs, such as the GATEWAY trial (Gastric Bypass to Treat Obese Patients with Steady Hypertension), to define their role in BP management.