GLP-1 Drugs and Blood Pressure: How Much It Falls, and What Happens When You Stop

GLP-1 drugs lower blood pressure, by about 4 to 7 points systolic more than placebo in the main weight trials, and slightly less when the trial population had type 2 diabetes.^[1][2] Most of the fall comes from weight loss, it shows up within the first six months, and in the trials where people were switched to placebo, much of it came back.^[4][1] No GLP-1 is approved to treat high blood pressure, and no trial has yet shown fewer strokes or heart attacks in people treated for that reason.^[7]

How much it falls, drug by drug

The FDA labels for Zepbound and Wegovy each carry a table of blood-pressure changes from their phase 3 trials. The figures below are the difference from placebo, in millimeters of mercury, at the end of each trial.

Two cautions on reading the table. The trials enrolled people whose average starting pressure was close to normal, about 123 systolic in SURMOUNT-1 and 127 in STEP 1, so they say more about people with mildly raised readings than about severe hypertension.^[1][2] And the labels flag these blood-pressure figures as secondary results that were not controlled for multiple testing.^[1][2] Across 85 randomized trials with 90,977 people, a 2026 meta-analysis put the average fall at 3.4 points systolic for GLP-1 drugs, 5.1 for dual agonists such as tirzepatide and 6.6 for triple agonists, with bigger weight loss bringing bigger falls.^[6]

What 24-hour monitoring showed

Office readings can be thrown off by the visit itself. SURMOUNT-1 ran a substudy of 600 participants who wore an ambulatory monitor for 24 hours at the start and again at week 36, with 494 providing usable readings both times.^[3]

The 24-hour systolic falls were at least as large as the office ones, and the authors report that night-time systolic pressure, which predicts cardiovascular risk more strongly than daytime readings, also fell at every dose.^[3] The diastolic effect was small and, at 15 mg, indistinguishable from placebo. Only a subset of the trial was monitored this way, and only at two time points.^[3]

How much of it is the weight loss

Most of it. In a post hoc analysis of SURMOUNT-1, weight loss explained 68% of the systolic fall and 71% of the diastolic fall.^[4] The pooled semaglutide analysis reached the same conclusion, that the reduction was mediated substantially by weight loss.^[5] The timing fits: pressure dropped quickly over the first 24 weeks on tirzepatide and then held steady to week 72, by which point 58.0% of people on the drug had normal blood pressure against 35.2% on placebo.^[4]

The part not explained by weight is small, a point or two, and its cause is uncertain. That matters for expectations: someone who loses little weight on a GLP-1 should not count on much change in blood pressure, and the drug’s benefit on pressure grows with the weight it takes off.

High and low blood pressure as side-effect reports

Trials also record blood-pressure problems as adverse events. A 2026 meta-analysis of 32 randomized trials with 47,332 participants found that reports of hypertension were less than half as common on tirzepatide as on comparators (risk ratio 0.40), while reports of low blood pressure were more common (risk ratio 2.45), especially at higher doses.^[10] Semaglutide showed no significant change in either direction in that analysis.^[10] The two findings are the same effect seen from both ends: a drug that lowers pressure helps people whose pressure is high and can overshoot in some of the people taking it.

Dose made less difference to the average fall than might be expected. In SURMOUNT-1 the three tirzepatide doses brought office systolic pressure down by much the same amount, and in the ambulatory substudy the 10 mg dose showed the largest fall.^[1][3] Zepbound’s label also reports greater systolic falls than placebo in its two sleep apnea trials.^[1]

What happens to blood pressure when you stop

Two withdrawal trials answer this, and both labels report them. In SURMOUNT-4, everyone took tirzepatide for 36 weeks, during which systolic pressure fell by 11.2 points on average. Half were then switched to placebo. Over the next 52 weeks, systolic pressure rose 8.2 points on placebo and 2.0 points on tirzepatide.^[1] In STEP 4, after a 20-week semaglutide run-in, systolic pressure rose 4.4 points over the following 48 weeks in those switched to placebo, against 0.5 points in those who stayed on it.^[2][8]

So the lower readings belong to the treatment period. If a prescriber has reduced or stopped a blood-pressure medicine because of the weight loss, stopping the GLP-1 is a reason to recheck pressure over the following months. The article on stopping a GLP-1 covers the weight regain that drives this.

Is a GLP-1 a treatment for high blood pressure?

Not on its label. No GLP-1 lists hypertension among its indications. A 2026 Cochrane review of weight-loss drugs in people with hypertension found one semaglutide trial (274 participants) and one tirzepatide trial (153 participants with stage 2 hypertension) reporting separate results, and neither reported deaths or cardiovascular events for those people.^[7] The reviewers concluded the evidence was insufficient to say whether the drugs reduce deaths or cardiovascular disease in people with hypertension.^[7]

That gap is narrower than it sounds for people with established heart disease. The SELECT trial found fewer heart attacks, strokes and cardiovascular deaths on semaglutide in people with overweight and established cardiovascular disease, the basis of Wegovy’s heart indication.^[2] It was designed around heart disease, though, not blood pressure. For someone whose main problem is high blood pressure, a GLP-1 is an addition to standard treatment, not a substitute for it.

Blood pressure does appear in coverage rules. Medicare’s GLP-1 Bridge counts uncontrolled high blood pressure as a qualifying condition for people with a BMI of 30 or higher.^[9] Commercial plans vary; the member’s own plan documents decide.

If you already take blood-pressure pills

• Doses often come down. In the pooled STEP data, people on semaglutide ended with a lower blood-pressure treatment intensity than those on placebo.^[5] The details, including how often people stopped all their pills, are in our article on dizziness and blood-pressure pills.
• Changes are the prescriber’s call. Home readings over several weeks are more useful to bring to that conversation than a single clinic number. Light-headedness on standing is a reason to raise it sooner.
• Vomiting and diarrhea change the picture. The Wegovy label warns that most reported cases of acute kidney injury on semaglutide followed stomach side effects that led to dehydration, and it tells prescribers to monitor kidney function in people with those symptoms.^[2] The interaction checker lists common combinations with blood-pressure drugs.

Blood pressure is one of several numbers these drugs move along with weight. Blood sugar is covered in GLP-1 drugs for prediabetes, and the effect on leg arteries in semaglutide and peripheral artery disease.