New weight loss drug may be an effective strategy for preventing or treating high blood pressure

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The new weight-loss drug tirzepetide significantly reduced systolic blood pressure (the top number in a blood pressure reading) in nearly 500 obese adults who took the drug for about eight months, according to new research published today. high blood pressureAn American Heart Association Journal.

Systolic blood pressure, or the top number in the blood pressure reading, is a stronger predictor of cardiovascular death than diastolic, or the bottom number, blood pressure. According to the American Heart Association’s 2024 heart disease and stroke statistics, more than 122 million adults in the United States, or 47% of adults, have high blood pressure, and about 42% of adults are obese.

Tirzepatide works by mimicking two metabolic hormones in the body: it acts as a glucose-like peptide-1 (GLP-1) receptor agonist and as a glucose-dependent insulinotropic polypeptide (GIP) receptor agonist. These hormones stimulate insulin secretion and sensitivity after a person eats. Together, they help regulate the body’s blood sugar levels, slow digestion, and reduce appetite, which makes a person feel fuller and eat less, leading to weight loss. In contrast, semaglutide contains only the GLP-1 hormone; It does not contain a GIP receptor agonist.

In 2022, the Food and Drug Administration approved tirzepatide for prescription as a treatment for type 2 diabetes. By the end of 2023, the FDA approved it for long-term weight management in obesity (30 kg/m body mass index).2 or more) or overweight (body mass index 27-29 kg/m2) and at least one weight-related health condition, such as high blood pressure, type 2 diabetes, or high cholesterol.

“Our results suggest that treating obesity with the weight-loss drug tirzepetide may be an effective strategy for preventing or treating hypertension,” said lead study author James A. De Lemos, MD, FAHA, Kern Wildenthal, MD, Ph.D. , distinguished chair of cardiology and professor of medicine at UT Southwestern Medical Center in Dallas. “Although tirzepetide has been studied as a weight-loss drug, the reduction in blood pressure in our patients in this study was impressive. Although it is not known whether the effect on blood pressure was caused by the drug or by the participants’ weight loss, the lower “blood pressure measurements seen with tirzepetide are compared to many hypertension medications. compete with.”

The current study was a planned substudy of the SURMOUNT-1 weight loss study to determine whether it had an effect on blood pressure in 600 participants. The substudy was designed to evaluate the effect of tergepeptide on blood pressure levels measured by 24-hour ambulatory blood pressure monitoring in subjects with obesity but without type 2 diabetes.

Participants received a placebo or a dose of tirzepatide in one of three strengths (5 mg, 10 mg or 15 mg). About one-third of the participants reported that they had high blood pressure at the start of the study and were taking one or more high blood pressure medications. When the substudy began, all participants had blood pressure levels less than 140/90 mm Hg, and if they were using blood pressure medication, they had to take their blood pressure medication for at least three months. The sub-study included participants with high blood pressure and those with normal blood pressure.

The study was conducted from December 2019 to April 2022, and the participants’ results after 36 weeks of taking tirzeptide indicated:

  • For participants receiving 5 mg tirzepatide, there was a mean reduction in systolic blood pressure of 7.4 mm Hg.
  • For participants receiving 10 mg tirzepatide, there was a mean reduction in systolic blood pressure of 10.6 mmHg.
  • For participants receiving 15 mg tirzepatide, there was a mean reduction in systolic blood pressure of 8.0 mm Hg.
  • The blood pressure-lowering effect of tirzepetide was evident in blood pressure measures taken both during the day and at night. Nighttime systolic blood pressure is a stronger predictor of cardiovascular mortality and all-cause mortality than daytime blood pressure readings.

Reductions in systolic blood pressure were consistent across subgroups of study participants who were stratified by additional factors, including age, gender, body mass index, and hypertension-related risk factors.

Study Background and Details:

  • Surmount-1 was a randomized study on the effect of increasing doses of tergepeptide on weight loss. It was found that among participants with overweight or obesity (body mass index (BMI) ≥27 kg/m2), once-weekly injections of 5 mg, 10 mg, or 15 mg of tirzepetide resulted in weight loss of 15%, 19.5%, and 20.9%, respectively, compared with placebo.
  • Sub-study SURMOUNT-1 included 600 adults: 155 participants received placebo; 145 were receiving tirzepatide 5 mg; 152 were receiving tirzepetide 10 mg; and 148 were receiving tirzepetide 15 mg.
  • Blood pressure measurements were available and analyzed for 494 participants who had valid ambulatory blood pressure monitoring data at the start of the study and at week 36.
  • Only study participants with at least 70% valid readings of ambulatory monitoring and a minimum of 20 days and seven nights of readings were included in the data analysis. This was 494 of the 600 initial participants.
  • 69% of study participants self-identified as female, and 31% self-identified as male. 66.8% self-identified as white adults, 11.8% self-identified as black adults, and 25% self-identified as Hispanic.
  • The mean age of the participants was 45.5 years, and their mean BMI was 37.4 kg/m2, which meets criteria for obesity (obesity is BMI≥30). People with obesity are at risk for high blood pressure, heart disease, stroke and type 2 diabetes, as well as other health conditions.
  • Ambulatory blood pressure monitoring used in this study included blood pressure measurements every 30 minutes during the day and hourly at night, providing a more comprehensive assessment of blood pressure than office or daily home blood pressure measurements. For ambulatory blood pressure monitoring, study participants wore a blood pressure monitoring device for a 24- to 27-hour period that measured blood pressure throughout waking and sleeping periods. Ambulatory blood pressure was monitored when participants first started taking tirzepatide at the start of the study and after 36 weeks of study enrollment.

The 2017 ACC/AHA Guidelines for the Prevention, Detection, Evaluation, and Management of Hypertension in Adults classify high blood pressure, or hypertension, as the upper and lower blood pressure greater than or equal to 130/80 mm Hg.

Limitations of the study include that it was conducted only in a subset of the original 2,539 SURMOUNT-1 participants; Ambulatory blood pressure monitoring was measured at only two points in the study -; at baseline and at 36 weeks; and measurements were taken once every hour during the night to reduce the burden on the study participants. In addition, changes in food intake and 24-hour urinary sodium excretion were not assessed, meaning that the contribution of dietary changes, including changes in salt intake or other changes that may help lower blood pressure, is unknown and cannot be estimated.

“Overall, these data are encouraging that novel weight-loss drugs are effective in reducing body weight and that they are also effective in improving the cardiometabolic complications of obesity, including hypertension, type 2 diabetes, and dyslipidemia. Equally important to these beneficial effects, many of these obesity-related complications are cardiovascular disease risk. work synergistically to increase. Thus, strategies to mitigate multiple obesity-related complications may reduce the risk of cardiovascular events,” Michael E. said Hall, MD, MS, FAHA, the association’s 2021 scientific statement on weight-loss strategies for the prevention and treatment of hypertension and chair of the Department of Medicine at the University of Mississippi Medical Center in Jackson, Mississippi.

Additional research will be needed to determine long-term effects on cardiovascular events such as heart attack and heart failure. Also, studies are needed to investigate what happens to blood pressure when drugs like tirzepetide are stopped – does blood pressure rebound, or does it stay low?


Michael E. Hall, MD, MS, FAHA, writing group chair

Co-authors and published manuscripts are listed. The study was funded by Eli Lilly & Company, the manufacturer of tirzepetide.

Source:

Journal Reference:

De Lemos, J. A., etc (2024) Tirzepatide reduces 24-hour ambulatory blood pressure in adults with body mass index ≥27 kg/m2: the SURMOUNT-1 ambulatory blood pressure monitoring substudy. high blood pressure doi.org/10.1161/HYPERTENSIONAHA.123.22022.



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