Blood Pressure Control Among U.S. Adults With Hypertension, Stratified by Glucagon-Like Peptide 1 (GLP-1) Receptor Agonist Use: Evidence From the National Health and Nutrition Examination Survey, 2017-2020

Background: Hypertension remains a major contributor to cardiovascular morbidity and mortality in the United States. Glucagon-like peptide 1 receptor agonists (GLP-1 RAs) are increasingly used in the management of type 2 diabetes and obesity, but population-level data describing blood pressure control among GLP-1 RA users with hypertension remain limited. Objective: To describe differences in blood pressure control between GLP-1 RA users and non-users among U.S. adults with hypertension using data from the National Health and Nutrition Examination Survey (NHANES) 2017 to March 2020. Methods: This cross-sectional study analyzed NHANES 2017 to March 2020 pre-pandemic data. Adults aged 18 years and older with hypertension were included. Current GLP-1 RA use was identified from prescription medication records. Blood pressure control was defined as mean systolic blood pressure <130 mmHg and mean diastolic blood pressure <80 mmHg. Survey weights, strata, and primary sampling units were applied to account for the complex sampling design. Descriptive statistics, survey-adjusted t tests, and survey-adjusted chi-square tests were used for group comparisons. Results: The final analytic sample included 4,016 adults with hypertension, of whom only 45 participants reported GLP-1 RA use. After applying NHANES sampling weights, GLP-1 RA users represented an estimated 994,028 (0.9%) U.S. adults, while non-users represented 104,940,242 (99.1%). The prevalence of controlled blood pressure was higher among GLP-1 RA users than non-users (659,630 (66%) vs. 24,950,382 (24%); design-adjusted F = 15.22, P = 0.001). GLP-1 RA users had a higher mean body mass index than non-users (37.25 ± 7.41 vs. 31.22 ± 7.22 kg/m², P = 0.008). Diabetes (988,214 (99%) vs. 18,545,714 (18%), P < 0.001)) and cardiovascular disease history (233,659 (24%) vs. 16,122,408 (15%), P = 0.035) were also more common among GLP-1 RA users. Conclusions: Among U.S. adults with hypertension, GLP-1 RA users demonstrated a higher prevalence of blood pressure control than non-users despite a greater burden of obesity, diabetes, and cardiovascular disease. These findings highlight the importance of continued investigation of blood pressure patterns among individuals receiving GLP-1 RAs in contemporary clinical practice.