GLP-1 Receptor Agonists and Blood Pressure: A State-of-the-Art Review of Mechanisms, Evidence, and Clinical Implications

Abstract

Background: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are widely used for the treatment of type 2 diabetes and, more recently, for weight management among individuals without diabetes. Aim: This review synthesizes the current evidence on the mechanisms by which GLP-1 RAs affect BP, their clinical effects across populations, and the implications for patient care. We discuss subpopulations who may benefit from their BP-lowering effects, identify limitations in the existing evidence, and explore future directions for research. Results: Beyond their metabolic effects, growing evidence suggests that GLP-1 RAs produce modest reductions in BP, typically 2-5 mm Hg systolic, across diverse populations with diabetes, obesity, or at high cardiovascular risk. These reductions appear to be driven primarily by weight loss, with additional contributions from potential weight-independent mechanisms such as natriuresis, improved endothelial function, and attenuation of vascular inflammation. Although smaller in magnitude than those achieved with traditional antihypertensive drugs, the BP-lowering effects of GLP-1 RAs can translate into meaningful cardiovascular risk reduction at the population level and provide additive BP benefit when used alongside conventional therapies. Among individuals with hypertension, GLP-1 RAs are generally well tolerated, although small increases in heart rate and potential interactions with volume-regulating medications may warrant clinical attention. Conclusion: As newer GLP-based therapies continue to emerge, a clearer understanding of their effects on BP may inform more integrated approaches to cardiometabolic care.