Does Ozempic Lower Blood Sugar & Pressure?

Ozempic (semaglutide) is an injectable GLP-1 receptor agonist that the Food and Drug Administration (FDA) approved to improve blood sugar levels in adults with type 2 diabetes.

Beyond blood sugar management, research suggests that Ozempic also lowers blood pressure. A 2023 systematic review and meta-analysis published in the Journal of Clinical Medicine found that semaglutide reduced systolic blood pressure by approximately 5 mmHg and diastolic blood pressure by about 2.5 mmHg in patients without diabetes. This blood pressure reduction is clinically meaningful even modest decreases in systolic BP are associated with lower cardiovascular risk.

The blood pressure-lowering effect appears to be driven primarily by weight loss (patients in the STEP trials lost 10-15% of body weight), though improvements in insulin sensitivity and vascular function may also contribute.

It is important to note that Ozempic is not FDA-approved for treating high blood pressure alone. The blood pressure improvements are considered a secondary benefit for patients taking semaglutide for diabetes or weight management.

TL;DR

• Yes, Ozempic (semaglutide) can lower blood pressure. 
• Clinical trials and systematic reviews consistently show that semaglutide reduces systolic blood pressure by approximately 3-5 mmHg on average. 
• This blood pressure reduction is largely driven by weight loss, improved insulin sensitivity, and possible direct effects on blood vessels. 
• However, Ozempic is not FDA-approved for treating high blood pressure as a standalone condition it is approved for type 2 diabetes management and cardiovascular risk reduction. 
• If you have hypertension, consult your healthcare provider about whether Ozempic may complement your current blood pressure medication.

How Ozempic Lowers Blood Sugar

The active ingredient in Ozempic is semaglutide, a GLP-1 receptor agonist that mimics a naturally occurring hormone released by the gut after eating. Semaglutide works through multiple mechanisms to lower blood sugar levels, making it highly effective for patients with type 2 diabetes. 

According to StatPearls (NCBI), semaglutide provides glucose-lowering effects in a glucose-dependent manner, which means it primarily stimulates insulin when blood sugar is elevated reducing the risk of low blood sugar (hypoglycemia) compared to some other medications.

In the SUSTAIN clinical trial program, approximately 60-75% of patients achieved a target A1C below 7% depending on dose. These blood sugar benefits typically begin within the first week of treatment and reach their peak effectiveness around month three. Semaglutide also helps patients lose weight an important secondary benefit that further improves blood sugar management and cardiovascular health.

Ozempic Dosage for Blood Sugar Control

Ozempic follows a gradual dose-escalation schedule to minimize gastrointestinal side effects. According to the FDA-approved prescribing information, patients start at 0.25 mg once weekly for the first four weeks (a dose-initiation phase not intended for blood sugar control), then increase to therapeutic doses.

The starting dose of 0.25 mg is gradually increased over several weeks. Most patients reach their maintenance dose within 8-16 weeks. Blood sugar benefits begin during the titration phase, but maximal A1C reduction is typically observed by month three. 

For weight loss, the same titration schedule applies, and patients often continue to see body weight reductions for six months or longer.

Does Ozempic Lower Blood Pressure?

Yes research consistently shows that Ozempic lowers blood pressure, though the effect is modest and indirect. 

A 2023 meta-analysis published in the Journal of Clinical Medicine analyzed six randomized controlled trials involving 4,744 participants and found that semaglutide reduced systolic blood pressure by approximately 4.83 mmHg and diastolic blood pressure by about 2.45 mmHg compared to placebo.

A separate 2024 meta-analysis in the journal Endocrine examining 29 trials with 26,985 participants with type 2 diabetes confirmed that semaglutide significantly reduced systolic blood pressure by about 2.31 mmHg compared to placebo or other antihyperglycemic agents. The larger reduction seen in non-diabetic patients may be related to the higher weight loss doses of semaglutide (2.4 mg) used in those trials.

The primary mechanism behind this blood pressure reduction is weight loss. Patients in the STEP trials lost an average of 10-15% of their body weight and even losing a small amount of weight can lower blood pressure or prevent it from rising. 

However, Ozempic does not act as a direct vasodilator. The blood pressure improvements typically emerge over months three to six of treatment as weight loss accumulates. 

Ozempic Blood Pressure Safety

There is no clinical evidence that Ozempic causes high blood pressure. In fact, the data consistently point toward modest blood pressure reduction rather than elevation. Low blood pressure (hypotension) is also rare occurring in fewer than 1% of patients and is typically related to dehydration caused by gastrointestinal side effects such as nausea, vomiting, or diarrhea.

Patients starting Ozempic should be monitored during weeks one through four, when nausea is most common and dehydration risk is highest. According to the Ozempic prescribing information, maintaining adequate hydration is important, especially during the initial dose-escalation phase. 

Most people with diabetes and controlled hypertension can safely take Ozempic, but individuals taking blood pressure medication should work closely with their healthcare provider blood pressure medications may need adjustment as weight loss occurs and blood pressure improves.

Additionally, Ozempic can affect how your body responds to low blood sugar levels when taken with certain other medications (such as sulfonylureas or insulin). Monitoring blood pressure and blood sugar levels more closely when starting Ozempic is recommended.

Ozempic Blood Sugar Safety – Hypoglycemia Risk

One of the advantages of semaglutide is its glucose-dependent mechanism it primarily stimulates insulin secretion when blood sugar is elevated. This means the risk of low blood sugar (hypoglycemia) with Ozempic alone is relatively low, at less than 2% in clinical trials.

However, when Ozempic is combined with insulin or sulfonylureas (medications that independently lower blood sugar), the hypoglycemia risk increases to approximately 6-10%. Symptoms of low blood sugar include shakiness, sweating, confusion, rapid heartbeat, and blurred vision. The standard treatment is consuming 15 grams of fast-acting glucose (such as glucose tablets or juice) and rechecking blood sugar levels after 15 minutes.

Your healthcare provider may reduce the dose of insulin or sulfonylureas when adding Ozempic to your diabetes drug regimen to minimize hypoglycemia risk. Regular blood sugar monitoring is essential, particularly during the first few months of treatment.

Ozempic Blood Clot Risk

There is no evidence that Ozempic increases the risk of blood clots compared to placebo. In fact, cardiovascular outcome trials have shown the opposite effect. 

The SUSTAIN 6 trial demonstrated that semaglutide reduced major adverse cardiovascular events (a composite of cardiovascular death, nonfatal heart attack, and nonfatal stroke) by 26% in patients with type 2 diabetes and established cardiovascular disease.

The more recent SELECT trial, published in the New England Journal of Medicine in 2023 and highlighted by the American Heart Association, showed a 20% reduction in major cardiovascular events in patients with overweight or obesity and pre-existing cardiovascular disease but without diabetes. 

Based on these findings, the FDA expanded Wegovy’s (semaglutide 2.4 mg) approval to include cardiovascular risk reduction. Ozempic is considered safe for patients with clotting disorders, and current evidence supports a favorable cardiovascular safety profile.

References

The Effect of Semaglutide on Blood Pressure 

Semaglutide and blood pressure: an individual patient data meta-analysis 

OZEMPIC Prescribing Information 

American Heart Association