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Tirzepatide, a dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist, is licensed in the UK for type 2 diabetes and chronic weight management. Marketed as Mounjaro, this once-weekly subcutaneous injection has demonstrated consistent reductions in both systolic and diastolic blood pressure across major clinical trials. Whilst not licensed as an antihypertensive agent, tirzepatide's blood pressure-lowering effects—primarily mediated through weight loss and metabolic improvements—offer additional cardiovascular benefits for patients with type 2 diabetes or obesity. Understanding these effects is essential for clinicians managing patients with multiple cardiometabolic risk factors.
Quick Answer: Yes, tirzepatide consistently lowers blood pressure, with clinical trials demonstrating mean reductions of 5–8 mmHg systolic and 2–4 mmHg diastolic, primarily through weight loss and metabolic improvements.
Tirzepatide is a 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. In the UK, tirzepatide is marketed as Mounjaro for its licensed indications. It is not indicated for type 1 diabetes or diabetic ketoacidosis.
The mechanism of action involves simultaneous activation of both GIP and GLP-1 receptors, which are naturally occurring hormones released from the gut in response to food intake. GLP-1 receptor activation enhances glucose-dependent insulin secretion from pancreatic beta cells, suppresses inappropriate glucagon release, slows gastric emptying, and reduces appetite through central nervous system pathways. GIP receptor activation complements these effects by further enhancing insulin secretion and may also influence fat metabolism and energy expenditure.
Administered as a once-weekly subcutaneous injection, tirzepatide is available in escalating doses (2.5 mg, 5 mg, 7.5 mg, 10 mg, 12.5 mg, and 15 mg) to optimise glycaemic control and weight reduction whilst minimising gastrointestinal side effects. The dose is typically titrated upwards every four weeks based on individual response and tolerability.
Beyond its primary indications for glycaemic control and weight loss, tirzepatide has demonstrated effects on several cardiovascular risk factors in clinical trials. These cardiometabolic effects include a small mean increase in heart rate. Tirzepatide can reduce the exposure to oral contraceptives, so barrier contraception is advised for 4 weeks after initiation and after each dose increase. It should be avoided during pregnancy and breastfeeding unless clearly necessary.
Clinical trial data consistently demonstrate that tirzepatide is associated with reductions in both systolic and diastolic blood pressure in people with type 2 diabetes and obesity. The SURPASS clinical trial programme, which evaluated tirzepatide across diverse patient populations, provides evidence for these cardiovascular effects.
In the SURPASS-2 trial, participants receiving tirzepatide experienced mean reductions in systolic blood pressure of approximately 5 to 8 mmHg compared to baseline, with higher doses generally producing greater effects. Diastolic blood pressure reductions of approximately 2 to 4 mmHg were also observed. These changes were statistically significant and potentially clinically meaningful, as even modest blood pressure reductions of this magnitude are associated with reduced cardiovascular event rates at a population level.
The SURMOUNT trials, which specifically evaluated tirzepatide for weight management in people without diabetes, similarly demonstrated blood pressure benefits. SURMOUNT-1 showed mean systolic blood pressure reductions of up to 7.4 mmHg with the 15 mg dose over 72 weeks, alongside substantial weight loss averaging 15–21% of baseline body weight.
Mechanisms hypothesised to underlie blood pressure reduction with tirzepatide include:
Weight reduction: Loss of adipose tissue decreases sympathetic nervous system activity, reduces cardiac output, and improves insulin sensitivity—all contributing to lower blood pressure
Natriuresis: GLP-1 receptor activation may promote sodium excretion through renal effects, though direct evidence for tirzepatide is limited
Improved endothelial function: Weight loss and metabolic improvements may enhance vascular health
Reduced inflammation: Adipose tissue reduction decreases pro-inflammatory cytokines that may contribute to hypertension
It is important to note that whilst the blood pressure reductions are consistent across trials, tirzepatide is not licensed as an antihypertensive agent. The blood pressure benefits appear to be secondary to its metabolic effects rather than direct vasodilatory action, and much of the effect correlates with weight loss.
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Tirzepatide should be considered within its licensed indications—type 2 diabetes or weight management—rather than solely for blood pressure reduction. However, the cardiovascular effects, including blood pressure lowering, may provide additional benefit for certain patient groups.
Patients who may derive particular benefit include:
People with type 2 diabetes and hypertension: This combination is extremely common, affecting a substantial proportion of people with type 2 diabetes. Tirzepatide addresses multiple cardiovascular risk factors simultaneously—glycaemic control, weight, and blood pressure—making it a therapeutic choice aligned with NICE guidance (NG28) on holistic cardiovascular risk management.
Individuals with obesity and elevated blood pressure: For those meeting criteria for weight management therapy, tirzepatide offers dual benefits of substantial weight loss and blood pressure reduction, potentially reducing the need for multiple antihypertensive medications. While the marketing authorisation covers BMI ≥30 kg/m² or ≥27 kg/m² with weight-related comorbidities, NHS prescribing follows NICE Technology Appraisal criteria, which are more restrictive.
Patients with metabolic syndrome: The cluster of hypertension, central obesity, dyslipidaemia, and insulin resistance may respond to tirzepatide's metabolic effects.
Those with treatment-resistant hypertension: Patients with resistant hypertension require adherence to NICE NG136 pathways and specialist review. Tirzepatide should not be initiated solely for blood pressure control, but its blood pressure effects may complement existing antihypertensive regimens in carefully selected patients.
NICE guidance recommends considering GLP-1 receptor agonists (including dual agonists like tirzepatide) for type 2 diabetes when additional glycaemic control is needed, particularly in those who would benefit from weight loss. The NICE Technology Appraisal for tirzepatide in weight management provides specific criteria for NHS prescribing.
It is essential to emphasise that tirzepatide should not be initiated solely for blood pressure control. Patients with hypertension should receive appropriate first-line antihypertensive therapy according to NICE hypertension guidelines (NG136), which recommend ACE inhibitors, angiotensin receptor blockers, calcium channel blockers, or thiazide-like diuretics as initial treatment depending on age, ethnicity, and comorbidities.
Whilst tirzepatide demonstrates a favourable safety profile in clinical trials, appropriate monitoring and patient education are essential to optimise outcomes and identify potential complications early.
Blood pressure monitoring recommendations:
Patients starting tirzepatide should have baseline blood pressure measurements recorded. For those already taking antihypertensive medications, regular blood pressure monitoring is particularly important during the initial months of treatment, as the blood pressure-lowering effects may necessitate adjustment of existing medications to prevent hypotension (excessively low blood pressure).
Symptoms of hypotension that patients should be aware of include:
Dizziness or light-headedness, particularly on standing
Fatigue or weakness
Blurred vision
Nausea
Fainting or near-fainting episodes
If these symptoms occur, patients should check their blood pressure if possible and contact their GP or diabetes specialist nurse for medication review. Dose reduction or temporary discontinuation of antihypertensive agents may be necessary.
Common adverse effects of tirzepatide that patients should anticipate include gastrointestinal symptoms—nausea, vomiting, diarrhoea, constipation, and abdominal discomfort. These are typically mild to moderate, occur predominantly during dose escalation, and diminish over time. Taking the injection on the same day each week and eating smaller, more frequent meals may help manage these effects.
Important precautions and safety considerations include:
Personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2 (precaution per UK SmPC)
Severe gastrointestinal disease
History of pancreatitis (requires careful assessment)
Diabetic retinopathy requiring close monitoring
Risk of gallbladder disease (seek care for persistent upper abdominal pain, fever, jaundice)
Dehydration and possible kidney injury with severe gastrointestinal symptoms (maintain hydration)
Small mean heart rate increase noted in trials (consider monitoring in patients with cardiovascular disease)
Reduced exposure to oral contraceptives (use barrier contraception for 4 weeks after initiation and dose increases)
Avoid during pregnancy and breastfeeding unless clearly necessary
When to seek urgent medical attention:
Severe, persistent abdominal pain (potential pancreatitis)
Signs of allergic reaction (rash, difficulty breathing, facial swelling)
Persistent vomiting leading to dehydration
Symptoms of hypoglycaemia if taking insulin or sulfonylureas concurrently
Blood pressure ≥180/120 mmHg or if chest pain, severe breathlessness, neurological symptoms, or acute confusion develop
Regular follow-up with healthcare professionals, typically every 3–6 months, allows for assessment of treatment response, adverse effects, and necessary adjustments to the overall treatment plan. Home blood pressure monitoring, if available, provides valuable data between appointments and empowers patients to participate actively in their care. Access to NHS blood pressure monitors varies by location, with some areas offering schemes such as BP@Home through GP surgeries and pharmacies. NICE recommends home monitoring as part of hypertension management where feasible.
Patients should report suspected side effects via the MHRA Yellow Card scheme (yellowcard.mhra.gov.uk).
Clinical trials demonstrate that tirzepatide reduces systolic blood pressure by approximately 5–8 mmHg and diastolic blood pressure by 2–4 mmHg, with higher doses generally producing greater effects. These reductions are statistically significant and potentially clinically meaningful at a population level.
No, tirzepatide is not licensed as an antihypertensive agent and should not be initiated solely for blood pressure control. It is licensed for type 2 diabetes and chronic weight management, with blood pressure reduction being a secondary benefit that complements its primary metabolic effects.
Patients already taking antihypertensive medications should have regular blood pressure monitoring during the initial months of tirzepatide treatment, as dose reduction or temporary discontinuation of blood pressure medications may be necessary to prevent hypotension. Contact your GP or diabetes specialist nurse if you experience dizziness, light-headedness, or other symptoms of low blood pressure.
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