The short answer on semaglutide and blood pressure: in trials, it tends to come down by a few points. In STEP 1, a 2021 trial of 1,961 adults without diabetes, the top number fell an average of 6.2 points on semaglutide and 1.1 points on placebo, a look-alike shot with no drug in it. That's a gap of about 5 points. The bottom number moved about 2 points more than placebo. Most of the change traveled with weight loss, and every figure below is a group average, not a forecast for one person.
Semaglutide and blood pressure: the trial numbers
Two quick definitions. The top number, systolic pressure, is the push inside the arteries as the heart squeezes; the bottom number, diastolic, is the pressure between beats. Both are counted in mmHg (millimeters of mercury), the unit on every cuff reading.
The Wegovy prescribing information, revised June 2026, lists the blood-pressure change in each of its large trials. Here is the top number:
| Trial: who, and for how long | Starting top number | Semaglutide | Placebo | Gap |
|---|---|---|---|---|
| STEP 1: adults without diabetes, 68 weeks | 126 | −6.2 | −1.1 | −5.1 |
| STEP 2: adults with type 2 diabetes, 68 weeks | 130 | −3.9 | −0.5 | −3.4 |
| STEP 3: with intensive lifestyle coaching, 68 weeks | 124 | −5.6 | −1.6 | −3.9 |
| SELECT: 17,604 adults with heart disease, week 104 | 131 | −3.8 | −0.5 | −3.3 |
| STEP UP: the 7.2 mg weekly dose, 72 weeks | 131 | −10.1 | −4.8 | −5.3 |
| OASIS 4: a 25 mg daily tablet, 64 weeks | 131 | −7.0 | −5.4 | −1.6 |
The first four used the 2.4 mg weekly shot. In STEP 1, the semaglutide group's average went from about 126 to about 120. The STEP 1 paper pairs that with a 14.9% average weight loss and broader gains in heart-risk measures (Wilding and colleagues, New England Journal of Medicine, 2021).
The gap sits around 3 to 5 points in almost every trial, even at 7.2 mg. It's smaller in STEP 2, where everyone had type 2 diabetes and weight loss was smaller too: 9.6% against 14.9%. The tablet trial is the odd one out, because its placebo group dropped more than usual.
How much does semaglutide lower blood pressure in hypertension?
Most people in these trials started near 125/80, slightly above the normal range in current U.S. guidelines. So researchers pooled the records of 3,136 people from STEP 1, 3 and 4 and sorted them by where they started (Kennedy and colleagues, European Heart Journal, 2024):
| Starting group | Semaglutide | Placebo | Gap |
|---|---|---|---|
| Diagnosed, treated, or top number above 130 | −6.2 | −1.6 | −4.6 |
| Top number above 130 | −12.1 | −7.0 | −5.1 |
| Top number above 140 | −17.4 | −12.6 | −4.8 |
Read the placebo column first. People starting above 140 dropped more than 17 points on semaglutide, but nearly 13 on placebo; the authors point to the trial setting itself, with careful check-ins and steadier use of existing medicines. The share owed to semaglutide stayed between about 4 and 5 points at every starting level.
Weight carried most of it. Adjusted for weight change, the gap shrank to about 1 point and was no longer statistically clear; by their estimate, weight loss accounted for roughly 89% of semaglutide's effect on the top number.
What a 5-point drop means
Five points sounds small, but it isn't nothing. Across 48 trials of blood-pressure medicines covering 344,716 people, each 5-point drop in the top number went with about a 10% lower risk of a major cardiovascular event, meaning a stroke, a heart attack, or heart failure that led to a hospital stay or death, over roughly four years (Blood Pressure Lowering Treatment Trialists' Collaboration, The Lancet, 2021). That held even when pressure started in the normal range.
That benchmark comes from blood-pressure drugs, not semaglutide, so it can't be carried over point for point. Semaglutide's own heart trial counted events directly: 6.5% of the semaglutide group had a heart attack, stroke or cardiovascular death, against 8.0% on placebo, over a little more than three years. The SELECT trial results explain who was enrolled.
One gap remains: a Cochrane review updated in June 2026 found just one semaglutide trial reporting separately on people with high blood pressure, 274 of them, and no data on deaths or heart events (Spary-Kainz and colleagues, Cochrane Database of Systematic Reviews, 2026).
What the newest evidence adds
As of September 23, 2026, the day this article was written, the SELECT investigators had just published an analysis of why heart events fell (Colhoun and colleagues, European Heart Journal, 2026). They followed two years of changes in weight, waist size, blood pressure, blood sugar, cholesterol, inflammation and kidney measures. Semaglutide improved all of them, yet no single change, and not all of them together, could account for the lower event rate with any certainty. Blood pressure is one thread in that story, not the whole explanation.
A second pooled study, published August 15, 2026, counted blood-pressure problems reported as side effects across 32 trials and 47,332 people (Chen and colleagues, Endocrine, 2026). With semaglutide, neither high-pressure nor low-pressure events differed clearly from comparison groups. Tirzepatide looked different: fewer high-pressure events, but low-pressure events 2.45 times as often. Tirzepatide and blood pressure lays out that medicine's own numbers.
Ozempic and blood pressure in type 2 diabetes
The Ozempic prescribing information, revised May 2026, gives no blood-pressure change, so the numbers come from pooled trials. A 2024 analysis of 29 trials and 26,985 people with type 2 diabetes, including the SUSTAIN and PIONEER programs, found the top number about 2.3 points lower with semaglutide than with placebo or other diabetes medicines, and about 3 points lower than placebo alone (Wu and colleagues, Endocrine, 2024). The bottom number didn't meaningfully change.
Time matters too. In SOUL, which tested semaglutide tablets against placebo in 9,650 adults with diabetes and heart or kidney disease, the gap was 3.8 points at 13 weeks and 1.8 points after three years (Mulvagh and colleagues, JAMA Cardiology, 2026).
When blood pressure drops too far
Lower isn't automatically better. In the Wegovy weight-loss trials, low-pressure side effects, including orthostatic hypotension (pressure that drops on standing up), were reported in 1.3% of people on semaglutide versus 0.4% on placebo. Fainting was reported in 0.8% versus 0.2%. The label ties some cases to stomach side effects and fluid loss, and says they were more frequent alongside blood-pressure medicine.
Fluid loss also strains the kidneys: the label's acute kidney injury warning mostly involves people dehydrated by nausea, vomiting or diarrhea.
Sometimes the answer is less blood-pressure medicine. In the pooled STEP data, 7.1% of people on semaglutide had their blood-pressure treatment scaled back, against 3.5% on placebo. Among 111 people with hard-to-treat high blood pressure, it was 26.9% versus 3%. Those medicines aren't something to change alone; a prescriber may lower a dose if readings keep falling. Fainting, chest pain or sudden confusion need urgent care.
One number moves the other way. Resting heart rate rose about 3.5 beats a minute on semaglutide in STEP 1 and dipped 0.7 on placebo. Semaglutide and heart rate covers that side.
Does blood pressure go back up after stopping?
In STEP 4, 803 people took semaglutide for 20 weeks and were then randomly assigned to keep taking it or switch to placebo. By week 68, the top number had risen 4.4 points in the switched group and 0.5 points in those who stayed on it. What happens when you stop taking semaglutide covers the rest of that picture.
Where compounded semaglutide fits
Every number above comes from branded semaglutide in trials. Through Promise, semaglutide is dispensed as a compounded medication, which is different from an FDA-approved product: the formulation offered here is not FDA-approved, and those trial figures can't simply be assumed to carry over to it. A licensed provider may still prescribe a compounded formulation; that decision is between the patient and the doctor.
At Promise, a licensed provider reviews every request, and not everyone qualifies. Current readings and blood-pressure medicines belong in that review, because they shape what gets watched once treatment starts.
