Blood Pressure Not Improving Despite Major Weight Loss on GLP-1s

I tried combining retatrutide with tirzepatide for a bit not expecting any blood pressure benefit just to test tolerance. The readings did not change compared with high dose tirzepatide alone around 13 mg versus 7.5 plus 5. I only stayed on the mix for about two weeks so I may give it longer next time. I admit I eat quite a bit of prepared food and once I turned on sodium tracking the numbers looked high. Since August I have been walking an hour most days now six days a week and added some light strength work in October. I will ask about other medication options thanks for the thoughts.

I tried beet root but either it did not help or I did not continue long enough. I am fine taking something ongoing if it is natural rather than prescription pressure medicines.

Thanks I share the dislike of permanent medicines. I expected the weight loss to let me stop the pressure pills but that has not happened. The same situation exists with metformin my doctor wants me to stay on it too. The pressure medicines feel necessary but I am unsure about continuing metformin without a clear reason to stop.

Are you continuing the pressure medicines and what dose of retatrutide are you using now?

Yes still taking the pressure medicines even though they seem to do little. The retatrutide dose just increased to 3 mg so it is not a high amount that is moving the pressure.

No they have not checked for secondary causes that I know of.

Can you name the exact model you use and whether large cuffs are available for it?

Please ask them to check. Secondary hypertension is uncommon about five percent of cases but it is still possible.

The clinic uses a reliable brand that offers large cuffs. Any model from that same maker works well.

I eat a banana daily partly for fiber but mainly because it seems to help pressure. Eating more than one can add benefit. Years ago while dieting I ate two or three a day and pressure dropped quite low though I was younger then.

Thank you.

Dietary sodium does not always match blood sodium levels which you probably already know. Low blood sodium is often managed by limiting fluids. I have a condition that causes me to dilute my blood volume when I drink so sodium drops. Your level of 118 is serious and can cause real harm so going to the ER was the right move. What keeps my sodium stable is a specific steroid plus strict fluid limits under 60 ounces daily along with regular lab checks. I mention this only because you are seeking ideas.

That is useful information thank you. I was already thinking I should get fresh labs to see where things stand. I still do not understand why it happened.

Sorry that was rough. Bodies respond to sodium in a U shape both too much and too little cause trouble. The warnings focus on excess so people may not realize very low intake is also possible. The same pattern holds with water. When I eat cleanly I can fall below 500 mg sodium daily which is too low for me and brings palpitations and lightheadedness. Most days I overshoot because of processed foods. It is uncommon but possible to run too low and electrolytes matter for nerve signals. Always discuss with your doctor but tracking can show your personal pattern.

Thanks for the follow up. I track sodium and electrolytes with help from my naturopath. I also learned my body does not do well on an extremely clean diet of only meat and vegetables. I need some carbohydrate to feel fueled and I rarely eat processed food except for occasional treats. I buy organic when possible. The low sodium episode was frightening but taught me a lot.

Telmisartan works well for full day control. It can modestly improve insulin sensitivity and reduce visceral fat. Because it reaches the brain it may lower inflammation there and help protect cognitive function or reduce migraine and other neurological issues though research continues. Chlorthalidone gives better 24 hour coverage than HCTZ. For people with higher A1c history indapamide may be preferable because it controls pressure similarly with fewer effects on electrolytes and metabolism. A combination of 20 mg telmisartan 2.5 mg amlodipine and 1.25 mg indapamide can be doubled for stronger effect and is available as separate generics.

I plan to look into indapamide. Recent labs showed HCTZ may be lowering potassium despite heavy electrolyte intake and it might also affect lipids and insulin sensitivity. My fasting glucose was 87 mg per dL and retatrutide is helping that. I reviewed results with an AI tool while on TRT plus a mild cycle. I will get another panel in six weeks. Morning reading today was 115 over 70.

January 5 labs showed potassium at 3.3 mmol per L just below the 3.5 to 5.3 reference range. Not drastic. I may halve the HCTZ and ask about indapamide at the next visit. This morning the reading was 110 over 66.

Primary aldosteronism is another condition doctors are screening for more often these days and it can cause resistant hypertension.

When I had low potassium from HCTZ I was eventually diagnosed with primary aldosteronism. I told my doctor the diuretic caused it because levels were normal before but they still wanted me to continue. Most doctors do not screen under older rules though newer 2025 guidelines recommend checking anyone with resistant hypertension regardless of potassium. I ended up on an aldosterone blocker plus other medicines and pressure finally reached the low normal range. The updated guidance calls for broader screening even when potassium is normal because the condition is treatable and fairly common.

That article is interesting. I recently asked my naturopath to help find a pressure medicine that actually works for my genetic high readings so I will send it to her. Thanks for posting.

Thanks. I have wondered how much apparent genetic high pressure is actually primary aldosteronism which took a long time to diagnose in my case because many doctors still think it is rare. A new medicine called baxdrostat is expected in the second quarter of 2026 and I am interested in trying it since it targets aldosterone production directly.

From what I've gathered excess amounts of this hormone end up damaging both the heart and kidneys by triggering swelling scar tissue buildup and free radical activity which then leads to problems such as weakened heart pumping thickened left ventricle chamber gradual loss of kidney filtering ability and more frequent serious circulation events well past its usual influence on fluid and mineral balance through sodium retention it also drives changes in heart structure hurts energy producing parts inside cells and ramps up damaging reactions in both organs so blocking the receptor sites becomes important for protection in the kidneys it sparks swelling and scarring that hurts filtering units and tiny support cells it pushes the organs into overdrive mode which slowly wears them down and it creates reactive molecules that injure tissue in the heart it encourages muscle thickening and stiffening which raises chances for pump failure and irregular beats it boosts those same reactive molecules inside heart cells which harms energy factories and cuts power output it thickens artery walls and disrupts inner lining function and it lifts the odds of sudden vessel blockages brain events or abrupt heart stoppage it attaches to the receptor acting either as a gene switch or quick signal starter and it turns up an enzyme that makes more reactive molecules certain blockers at those receptor sites stop the downsides on both organs while substances that fight oxidation can limit the cell harm.

That argument supports using receptor antagonists such as spironolactone or eplerenone but does not explain why preventing synthesis would be more protective than blocking the receptor.

Bananas are one of my favorites. I will try eating one daily for a week and see whether pressure moves.