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Tirzepatide is a dual GIP and GLP-1 receptor agonist licensed in the UK for type 2 diabetes mellitus and chronic weight management in adults with obesity or overweight with weight-related comorbidities. As with other GLP-1 receptor agonists, questions have emerged regarding its cardiovascular effects, particularly on heart rate. Current evidence demonstrates that tirzepatide can cause modest increases in resting heart rate, typically 2–5 beats per minute compared to placebo. This article examines the clinical evidence, monitoring recommendations, and guidance on when to seek medical advice regarding tirzepatide-related heart rate changes.
Quick Answer: Tirzepatide can cause a modest increase in resting heart rate, typically 2–5 beats per minute compared to placebo, as documented in clinical trials and listed in the UK Summary of Product Characteristics.
Tirzepatide is a dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist licensed in the UK for the treatment of type 2 diabetes mellitus and, more recently, for chronic weight management in adults with obesity or overweight with weight-related comorbidities. As with other medications in the GLP-1 receptor agonist class, questions have arisen regarding its potential effects on heart rate.
Current evidence shows that tirzepatide can cause a modest increase in resting heart rate in some patients. According to the UK product information (SmPC), mean increases of approximately 2-5 beats per minute have been observed compared to placebo. This effect appears to be dose-dependent and is consistent with observations from other GLP-1 receptor agonists, which have demonstrated similar cardiovascular profiles.
The mechanism behind this heart rate increase is not fully established but may involve changes in autonomic nervous system activity or other physiological adaptations. Importantly, increased heart rate is listed as an adverse reaction in the tirzepatide SmPC, though serious arrhythmias have not been shown to increase in clinical trials to date. However, data remain limited and monitoring is advised, particularly in patients with pre-existing cardiac conditions.
For most patients, the modest heart rate changes observed with tirzepatide should be considered alongside the improvements in weight and glycaemic control, which are cardiometabolic risk factors. Individual responses vary, and healthcare professionals should monitor cardiovascular parameters, particularly in patients with pre-existing cardiac conditions or those taking medications that affect heart rate.
If you experience suspected side effects while taking tirzepatide, report them via the MHRA Yellow Card scheme (yellowcard.mhra.gov.uk or the Yellow Card app).
The cardiovascular safety profile of tirzepatide has been evaluated through large-scale clinical trials, most notably the SURPASS programme and the SURMOUNT studies. These trials provide important data regarding the cardiovascular effects of tirzepatide, including the observed modest increases in heart rate.
The SURPASS-CVOT (Cardiovascular Outcomes Trial) is an ongoing dedicated study designed to assess cardiovascular outcomes in patients with type 2 diabetes at increased cardiovascular risk. It is important to note that no established cardiovascular outcome benefit has been demonstrated yet, as this trial is still in progress.
In the SURPASS clinical trial programme, heart rate increases were documented with mean increases ranging from 1.4 to 4.6 beats per minute across different doses (5 mg, 10 mg, and 15 mg weekly) compared to baseline. These changes were generally stable over time and did not lead to increased rates of treatment discontinuation in most participants.
When considering heart rate changes, it's important to note that tirzepatide treatment is associated with other physiological effects. Patients treated with tirzepatide experienced significant reductions in body weight (up to 15% or more), improvements in HbA1c (reductions of 1.8–2.5%), and changes in blood pressure and lipid parameters. These improvements collectively affect cardiometabolic risk factors, though their impact on long-term cardiovascular outcomes awaits confirmation from the ongoing CVOT.
The Medicines and Healthcare products Regulatory Agency (MHRA) and the European Medicines Agency (EMA) have reviewed the available safety data and approved tirzepatide for use in the UK and Europe, indicating an acceptable benefit-risk profile based on current evidence. NICE has also issued technology appraisals supporting its use in appropriate patients with type 2 diabetes and for weight management.
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For healthcare professionals prescribing tirzepatide and patients taking this medication, proactive monitoring and management of cardiovascular parameters is recommended, particularly during treatment initiation and dose escalation. This aligns with the SmPC warning on increased heart rate. NICE guidance on diabetes management emphasises individualised treatment approaches that consider patient-specific cardiovascular risk factors.
Baseline cardiovascular assessment should be performed before initiating tirzepatide therapy. This includes:
Measurement of resting heart rate and blood pressure
Review of cardiovascular history, including arrhythmias, heart failure, or ischaemic heart disease
Assessment of concurrent medications that may affect heart rate (e.g., beta-blockers, calcium channel blockers, digoxin)
Evaluation of symptoms such as palpitations, chest pain, or dyspnoea
During treatment, patients should be advised to monitor for symptoms that may indicate heart rate changes, such as palpitations, dizziness, or unusual fatigue. Regular follow-up appointments should include heart rate and blood pressure measurements, particularly during dose escalation and the initial months of therapy. Consider more frequent checks during dose titration based on clinical judgement.
It's important to screen for reversible causes of tachycardia, including:
Dehydration
Infection
Anaemia
Thyroid dysfunction
Use of stimulants, decongestants or other medications affecting heart rate
Lifestyle modifications can help optimise cardiovascular health:
Adequate hydration, as dehydration can exacerbate tachycardia
Gradual increase in physical activity as weight loss progresses
Stress management techniques
Avoidance of excessive caffeine and stimulants
Smoking cessation support where applicable
For patients with pre-existing cardiovascular conditions, closer monitoring may be warranted. This includes individuals with a history of arrhythmias, heart failure, or those taking multiple cardiac medications. Consider temporary pause or slower up-titration if symptomatic tachycardia or marked heart rate increases occur. In such cases, collaboration between the prescribing clinician and cardiology services may be beneficial to ensure safe and effective treatment.
Patients taking tirzepatide should be educated about when heart rate changes warrant medical attention. While modest heart rate increases are expected and generally well-tolerated, certain symptoms and scenarios require evaluation by a healthcare professional.
Patients should contact their GP or healthcare provider if they experience:
Persistent palpitations – a sensation of rapid, fluttering, or pounding heartbeat that lasts for extended periods or occurs frequently
Significant changes in resting heart rate – particularly if this represents a notable increase from your baseline or is persistently elevated
Chest pain or discomfort – any chest tightness, pressure, or pain, especially if accompanied by shortness of breath, sweating, or radiation to the arm or jaw
Dizziness or lightheadedness – particularly if severe, recurrent, or associated with near-syncope (feeling faint)
Shortness of breath – new or worsening breathlessness, especially at rest or with minimal exertion
Syncope (fainting) – any loss of consciousness requires medical assessment
Immediate medical attention (999 or A&E) is required if:
Chest pain suggestive of acute coronary syndrome
Severe breathlessness or respiratory distress
Loss of consciousness or collapse
Heart rate that is very rapid with associated symptoms
For urgent but non-emergency concerns, NHS 111 can provide advice.
Routine review with a GP or diabetes specialist nurse is appropriate for:
Mild, intermittent palpitations without other concerning features
Questions about heart rate monitoring or medication interactions
Gradual increases in resting heart rate noted during home monitoring
General concerns about cardiovascular health while taking tirzepatide
Healthcare professionals should maintain a low threshold for further investigation in symptomatic patients, which may include electrocardiography (ECG), 24-hour Holter monitoring, or echocardiography as clinically indicated. Patient education is paramount – individuals should be reassured that small heart rate increases are expected but empowered to recognise and report symptoms that may indicate more significant cardiovascular concerns. Regular medication reviews ensure that tirzepatide remains appropriate and that any cardiovascular changes are identified and managed promptly, optimising both safety and therapeutic benefit.
Clinical trials show tirzepatide causes mean increases of approximately 2–5 beats per minute compared to placebo. This effect is dose-dependent and generally stable over time.
Yes, baseline and regular monitoring of heart rate and blood pressure is recommended, particularly during treatment initiation and dose escalation. Patients with pre-existing cardiovascular conditions may require closer monitoring.
Contact your GP if you experience persistent palpitations, significant heart rate increases, chest pain, dizziness, shortness of breath, or fainting. Seek immediate medical attention (999) for severe chest pain, collapse, or very rapid heart rate with concerning symptoms.
All medical content on this blog is created based on reputable, evidence-based sources and reviewed regularly for accuracy and relevance. While we strive to keep content up to date with the latest research and clinical guidelines, it is intended for general informational purposes only.
DisclaimerThis content is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare professional with any medical questions or concerns. Use of the information is at your own risk, and we are not responsible for any consequences resulting from its use.
