Effects of GLP-1 RAs on blood pressure in young overweight/obese patients with new-onset hypertension: a multicenter, real-world prospective cohort study
H Li, J Wen, J Luo, Y Zhao, L Bu, Y ZhangAbstract
Objective
To evaluate the effects of glucagon-like peptide-1 receptor agonist (GLP-1 RA)–based weight-loss therapy on blood pressure (BP) in young overweight/obese patients with new-onset hypertension; to compare rates of complete hypertension remission between isolated diastolic hypertension (IDH) and systolic-diastolic hypertension (SDH); and to quantify the dose–response relationship between weight loss and multidimensional home blood pressure monitoring (HBPM) parameters.
Methods
Participants aged 30–50 years with BMI ≥24 kg/m², antihypertensive drug-naïve new-onset hypertension, and a planned GLP-1 RA regimen (semaglutide or tirzepatide) were prospectively enrolled from two obesity specialty clinics in Shanghai and followed for six months. Standardized home BP diaries (three morning and three evening measurements per day for ≥5 consecutive days) were completed at baseline and at months 1, 3, and 6. A custom optical character recognition (OCR) system automated extraction and cleaning of handwritten diary data, deriving 15 HBPM parameters. The primary endpoint was complete hypertension remission, defined as morning mean systolic BP <130 mmHg and diastolic BP (DBP) <80 mmHg. Cox proportional-hazards models and generalized estimating equations (GEE) compared remission rates. Linear mixed-effects models and restricted cubic splines (RCS) characterized the dose–response relationship between BMI change and BP parameters.
Results
Seventy-eight participants were enrolled (IDH, n=46 [59.0%]; SDH, n=32 [41.0%]; semaglutide, n=49 [62.8%]; tirzepatide, n=29 [37.2%]), with balanced baseline characteristics across subgroups. Complete hypertension remission was significantly higher in IDH than SDH (56.5% vs. 21.9%; P=0.002). Kaplan–Meier curves diverged from day 30 (log-rank P=0.007). Adjusted Cox model showed IDH associated with >3-fold higher remission probability vs. SDH (HR 3.21, 95% CI 1.42–7.26; P=0.005); GEE confirmed this (OR 5.00, 95% CI 1.83–13.65). Tirzepatide yielded greater BMI reduction than semaglutide (−15% vs. −11%; P=0.001), but remission rates were similar (adjusted HR 1.50, 95% CI 0.69–3.25; P=0.302). Linear mixed-effects models indicated each 1 kg/m² BMI increase linked to 2.30 mmHg rise in morning systolic BP (P<0.001) and 1.51 mmHg in morning DBP (P<0.001); weight loss also reduced BP variability. RCS revealed concave, nonlinear dose–response: BP declined steeply with initial weight loss, plateauing later; ~2 kg/m² BMI reduction sufficed for meaningful DBP time-in-target-range (TTR) improvement.
Conclusions
IDH independently predicts complete hypertension remission during GLP-1 RA therapy, highlighting etiological subtype stratification for personalized interventions. Modest early weight loss drove significant BP gains.K–M curves for complete HTN remission