Encyclopedia entry

Hypertension as a comorbidity

Hypertension (raised blood pressure) is one of the weight-related comorbidities that counts toward NICE TA1026 eligibility for NHS Mounjaro. It is the most prevalent comorbidity across the eligible population. UK diagnostic thresholds are set by NICE NG136 and accept either clinic measurement or ambulatory or home blood pressure monitoring.

UK diagnostic thresholds

• · Stage 1 hypertension: clinic BP 140/90 mmHg or higher, confirmed by ambulatory or home monitoring at 135/85 or higher.
• · Stage 2 hypertension: clinic BP 160/100 or higher, confirmed by ABPM or HBPM at 150/95 or higher.
• · Severe hypertension: clinic BP 180/120 or higher.
• · Diagnosis requires confirmation across two measurement methods, not a single elevated reading.

The obesity link

Weight gain raises blood pressure through multiple mechanisms: increased blood volume, sympathetic nervous system activation, sodium retention, and altered renin-angiotensin-aldosterone signalling. Population data suggests approximately 60 to 70 percent of hypertension cases in the UK are obesity-related at least in part. Weight loss of 10 percent typically reduces systolic BP by 5 to 10 mmHg.

Outcomes on GLP-1

Both SURMOUNT-1 (tirzepatide) and STEP-1 (semaglutide) reported significant blood pressure reductions as secondary endpoints, broadly consistent with the magnitude of weight loss. Patients on antihypertensive medications often need dose adjustment downward as weight loss progresses to avoid hypotension. This is one of the routine reasons for prescriber check-ins during GLP-1 therapy.

What counts for eligibility

A current hypertension diagnosis on the GP record, with or without treatment, counts as one comorbidity under TA1026. Pre-hypertension (130 to 139 systolic, 80 to 89 diastolic) does not count. The diagnosis must be formally on the patient record.

Related: NICE TA1026 · sleep apnoea.