SAT-717 - Blood Pressure and Weight Outcomes Following First-Time Use of GLP-1 Therapies in Adults with Diabetes

Objective: To assess changes in blood pressure, weight loss, and their correlation in adults with diabetes who are first-time glucagon-like peptide-1 (GLP-1) users six months after initiation, and to compare these outcomes across FDA-approved GLP-1 weight loss therapies.

Methods: This retrospective cohort study used data from the UC Health Data Warehouse. Adults with diabetes starting FDA-approved GLP-1 therapies for weight management (Saxenda®, Wegovy®, Zepbound®) with at least six months of data before and after treatment initiation were included. Medication adherence was assessed by calculating the proportion of days covered (PDC) following the first 90 days of therapy, with analysis restricted to patients with a PDC ≥ 0.80. Follow-up measurements of weight and blood pressure were defined as the closest record after six months of GLP-1 use, within a 90-day window. Propensity score-weighted linear regression models were then used to compare changes in systolic blood pressure across GLP-1 therapies.

Results: The final cohort included 361 patients (mean (SD) age: 54.1 (13.0) years; 65.9% female), with 48 Saxenda, 210 Wegovy, and 103 Zepbound users. 95.0% had a baseline BMI over 30 kg/m², with a baseline systolic blood pressure of 127.1 (15.7) mmHg and diastolic blood pressure of 75.1 (10.7) mmHg. At six-month follow-up, the average weight change was -21.4 (17.8) lb, with 70.4% achieving ≥ 5% weight loss and 46.3% achieving ≥ 10% weight loss. Systolic blood pressure decreased by 3.6 (17.2) mmHg and diastolic blood pressure by 0.7 (13.2) mmHg. Correlation analysis revealed a significant association between weight change and systolic blood pressure reduction (r = 0.138, P = 0.009), but not for diastolic blood pressure (r = 0.079, P = 0.136). In our propensity score-weighted regression model (adjusted R2 = 0.360), after adjusting for changes in weight, baseline measures, demographics, and comorbidities, changes in systolic blood pressure were not statistically different between GLP-1 categories (Wegovy vs. Saxenda: -0.448 mmHg, P = 0.861; Zepbound vs. Saxenda: 0.651 mmHg, P = 0.819). Each pound of weight loss was associated with a 0.179 mmHg reduction in systolic blood pressure (P < 0.001).

Conclusion: In adults with diabetes, systolic blood pressure changes did not significantly differ by GLP-1 therapy selection after adjusting for weight loss. Our results suggest that weight change is the primary driver of systolic blood pressure changes.

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