Wegovy may reduce need for antihypertensive, lipid-lowering therapies
Key takeaways:
- In the STEP trials, a higher proportion of adults receiving semaglutide stopped antihypertensive or lipid-lowering therapy vs. placebo.
- Findings were similar for adults with and without type 2 diabetes.
Adults receiving semaglutide for the treatment of obesity were more likely to have antihypertensive or lipid-lowering therapy tapered or discontinued than those receiving placebo, according to data from the STEP trials.
Researchers pooled data on antihypertensive and lipid-lowering medication use from the STEP 1, 2, 3, 6 and 8 trials in a post hoc analysis published in Obesity. Researchers found a higher proportion of adults receiving semaglutide 2.4 mg (Wegovy, Novo Nordisk) decreased the intensity of or stopped entirely using antihypertensive or lipid-lowering therapy at 68 weeks compared with placebo. Conversely, a higher percentage of participants assigned placebo increased the intensity of their antihypertensive or lipid-lowering therapy at 68 weeks compared with semaglutide.
“Overall, the study should compel clinicians to regularly assess a patient’s medications and determine if benefits still outweigh risks, especially in the setting of significant weight loss that might modify the need for those medications,” Beverly G. Tchang, MD, DABOM, assistant professor of clinical medicine at Weill Cornell Medicine, told Healio.
Tchang and colleagues conducted two analyses. The first analysis included adults with overweight or obesity and without diabetes, whereas the second analysis included adults with overweight or obesity plus type 2 diabetes. Antihypertensive and lipid-lowering therapy use was reported by the STEP trial investigators at baseline and 68 weeks.
In all five STEP trials, renin-angiotensin system inhibitors were the most common antihypertensive medications used, and statins were the most commonly used lipid-lowering drugs.
Antihypertensive medication
Among adults with obesity and without diabetes, 17.7% of the semaglutide group discontinued antihypertensive medications at 68 weeks compared with 9% of the placebo group. Antihypertensive therapy was tapered for 16.5% of participants receiving semaglutide and 4.8% of the placebo group. Therapy was increased in intensity for 14.2% of the placebo group vs. 8.3% of those receiving semaglutide.
Of adults with obesity plus type 2 diabetes, 9.8% receiving semaglutide discontinued antihypertensive therapy at 68 weeks vs. 7.3% of adults receiving placebo. Antihypertensive therapy intensity was lowered for 14.7% of the semaglutide group and 5.7% of adults receiving placebo, whereas 11.5% of the placebo group and 7.9% of adults receiving semaglutide had therapy intensified.
Lipid-lowering agents
Lipid-lowering therapy was discontinued at 68 weeks for 10.1% of adults with obesity and without diabetes receiving semaglutide and 4.5% receiving placebo. The proportion of adults with lipid-lowering therapy tapered was similar between the semaglutide (4%) and placebo groups (3.9%). Therapy intensification occurred in 9.7% of the placebo group vs. 2.1% of those receiving semaglutide.
Among adults with obesity and type 2 diabetes, 10.1% receiving semaglutide and 5.4% receiving placebo stopped using lipid-lowering therapy at 68 weeks. The percentage of adults who had a reduction in lipid-lowering therapy intensity was higher in the semaglutide group vs. the placebo group (4.6% vs. 0.9%). There was no significant difference in the percentage of adults who had treatment intensified at 68 weeks between the semaglutide and placebo groups (2.9% vs. 4.5%, respectively).
“Given guidelines on lipid management in type 2 diabetes, I was surprised at the percentage of participants where a lipid-lowering agent was discontinued,” Tchang said. “We do not have the granularity to know if a statin had been discontinued vs. a nonstatin. However, providers should remember that statins should be continued for cardiovascular risk reduction, even if weight and glucose are under control.”
Hypertension remission
Of adults with obesity and without diabetes, 13.7% receiving semaglutide achieved hypertension remission at 68 weeks compared with 6.2% in the placebo group. In the analysis of adults with obesity and type 2 diabetes, hypertension remission occurred in 5.7% of adults receiving semaglutide and 3.4% of those receiving placebo.
Tchang said more research is needed on how weight-related comorbidities are affected by obesity pharmacotherapy and to determine whether increasing or decreasing antihypertensive and lipid-lowering therapy intensity is clinically appropriate.
“In the case of blood pressure, the data seems to match our experiences in clinical practice, where significant weight loss allows patients to reduce or discontinue their BP medications because their BP is too low or are normal even without medications,” Tchang said. “However, we must be cautious with regimen changes for hyperlipidemia since weight loss does not improve LDL cholesterol to the degree that a statin would.”
For more information:
Beverly G. Tchang, MD, DABOM, can be reached at bgt9001@med.cornell.edu.
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