Beyond weight loss, tirzepatide may also lower high blood pressure: SURMOUNT-1
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Key takeaways:
- The dual incretin-based agonist tirzepatide was shown to reduce ambulatory blood pressure in a new SURMOUNT-1 substudy.
- The drug’s effect on blood pressure may be independent of weight loss.
The dual incretin agonist tirzepatide reduced 24-hour ambulatory BP for adults with obesity-related hypertension, with the effects potentially independent of weight loss, according to data from a planned substudy of the SURMOUNT-1 trial.
“Tirzepatide led to clinically meaningful reductions in ambulatory blood pressure among adults with overweight and obesity, with reductions in the range seen with traditional blood pressure-lowering medications,” James A. de Lemos, MD, professor of medicine and the Sweetheart Ball-Kern Wildenthal, MD, PhD, Distinguished Chair in Cardiology at UT Southwestern Medical Center, told Healio. “Pharmacological treatment of obesity with new effective medications may help to prevent and treat hypertension and its complications. However, mechanistic studies are needed to determine if the BP lowering is fully mediated by weight loss or if there are other effects of the drug that contribute.”
As Healio previously reported, nearly all of the 2,539 adults participants with obesity without diabetes in SURMOUNT-1 assigned tirzepatide (Zepbound, Eli Lilly), an injectable GIP/GLP-1 dual incretin-based agonist, experienced at least 5% weight loss over 72 weeks compared with placebo, with at least 20% weight loss in more than half with the highest 15 mg dose. The dramatic findings were hailed as part of a “new era” of obesity treatment.
For the prospectively planned substudy published in Hypertension, de Lemos and colleagues analyzed data from 600 of the SURMOUNT-1 participants with a BP less than 140/90 mm Hg and stable antihypertensive therapy, if used, including 145 assigned tirzepatide 5 mg, 152 assigned tirzepatide 10 mg, 148 assigned tirzepatide 15 mg, and 155 assigned placebo. This subgroup underwent 24-hour ambulatory BP monitoring (ABPM) at baseline and again at 36 weeks.
The baseline mean 24-hour systolic BP was 124.6 mm Hg, with no between-group differences.
Treatment with each tirzepatide dose reduced 24-hour systolic BP at 36 weeks compared with placebo. The placebo-adjusted systolic BP change from baseline was –7.4 (95% CI, –10 to –4.7) mm Hg for the 5 mg tirzepatide dose, –10.6 (95% CI, –13.2 to –8) mm Hg for the 10 mg dose, and –8 (95% CI, –10.6 to –5.4) mm Hg for the 15 mg dose. Results were consistent for both day and nighttime BP.
Participants assigned tirzepatide experienced an increase in heart rate across doses compared with placebo; at week 36, heart rate increased with tirzepatide vs. placebo by 2.1 (95% CI, 0.3-3.9), 2.3 (95% CI, 0.6-4.1) and 5.4 (95% CI, 3.6-7.1) beats per minute, with tirzepatide 5 mg, 10 mg and 15 mg, respectively.
The researchers cautioned that ABPM was only conducted among a subset of the larger SURMOUNT-1 population. Additionally, BP was only measured at baseline and one other time point, and measurements were only taken once per hour at night to minimize participant burden. The differences did not account for changes in food intake and 24-hour urine sodium excretion, which were not assessed.
“These data provide further evidence for the potential benefits of tirzepatide on cardiometabolic health and cardiovascular outcomes,” the researchers wrote.
The FDA approved tirzepatide for chronic weight management for adults with obesity or with overweight and one weight-related comorbidity in November. The drug was previously approved under the name Mounjaro for use by adults with type 2 diabetes to improve glycemic response.
For more information:
James A. de Lemos, MD, can be reached at james.delemos@utsouthwestern.edu.
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