Semaglutide Significantly Reduces Blood Pressure in Patients with Type 2 Diabetes

A recent systematic review from the University of Indonesia highlighting the effects of oral semaglutide on systolic blood pressure (SBP) in adults with type 2 diabetes mellitus (T2DM) has determined that SBP is substantially reduced because of the treatment.1

Presented by Oliver Emanuel Yausep, MD, faculty of medicine at the University of Indonesia, at the 9th Annual Heart in Diabetes Conference, these data suggest that semaglutide may have more potential for cardiovascular protection than its well-known glycemic benefits.1

High SBP is a well-known additive risk factor in patients with obesity and T2DM; it is directly connected to higher risks of morbidity and mortality. Additionally, the optimal blood pressure treatment target for these patients is still subject to debate.3

Semaglutide, a glycogen-like peptide-1 (GLP-1) receptor agonist with 94% amino acid sequence homology with native human GLP-1, effectively stimulates insulin and inhibits glucagon secretion, which leads to lower blood glucose levels with lower risk of hypoglycemia. Treatment typically results in weight loss, appetite reduction, and better control of eating.2

Despite how widely semaglutide is used, its cardiovascular impacts are relatively underreported. To that end, Yausep and colleagues collected data from past clinical trials and prospective studies from eight databases. An initial total of 422 studies were identified; after filtering for those evaluating SBP changes post-oral semaglutide administration, the team ended up with 5 studies for investigation.1

Collectively, the studies consisted of 4731 patients over a variety of timeframes. Of these studies, 3 were compared to baseline values, 1 compared semaglutide to placebo and standard of care, and 1 compared it with dapagliflozin and standard therapy. All but 2 of the studies were prospective, with the remainder being double-blind RCTs. In all 5 studies, SBP was reduced with oral semaglutide compared to placebo and baseline, with a range of -2.6 mmHg to -12.74 mmHg.1

Out of the 5 included studies, 4 reported statistically significant results (P <.05). The largest study, consisting of 3172 participants, reported the lowest reduction of -2.6 mmHg (95% CI: -3.7 to -1.5). An observational study consisting of 61 participants reported the highest reduction of -12.74 mmHg.1

Yausep and colleagues noted that these data indicate a substantial reduction in SBP in patients with T2DM who received oral semaglutide. Additionally, this reduction suggests potential cardiovascular protection beyond the treatment’s well-studied glycemic benefits. The team encourages broader use of semaglutide in T2DM patients, particularly those with a risk of hypertension.1

References

1. Yausep O, Christabelle M, Agarwal R, Baig I. The Effect of Oral Semaglutide on Systolic Blood Pressure in Patients with Type 2 Diabetes: A Systematic Review. Abstract presented at the 9th Annual Heart in Diabetes Conference in Philadelphia, PA, from June 6-8, 2025.

2. Aroda VR, Ahmann A, Cariou B, et al. Comparative efficacy, safety, and cardiovascular outcomes with once-weekly subcutaneous semaglutide in the treatment of type 2 diabetes: Insights from the SUSTAIN 1-7 trials. Diabetes Metab. 2019;45(5):409-418. doi:10.1016/j.diabet.2018.12.001

3. Wijkman MO, Claggett B, Diaz R, et al. Blood pressure and mortality in patients with type 2 diabetes and a recent coronary event in the ELIXA trial. Cardiovasc Diabetol. 2020;19(1):175. Published 2020 Oct 12. doi:10.1186/s12933-020-01150-0