Dumb question — does semaglutide lower blood pressure directly or is it only from the weight loss?
Not a dumb question at all. The answer is probably both. The SELECT trial showed blood pressure reductions that were somewhat greater than what would be expected from weight loss alone, suggesting a modest direct vascular effect. Proposed mechanisms include improved endothelial function, reduced arterial stiffness, mild natriuresis (sodium excretion), and reduced sympathetic nervous system activity. But the majority of the benefit is weight-loss mediated.
I track this stuff: the SELECT trial showed an average systolic reduction of about 3.4 mmHg beyond what weight loss alone would predict. Meaningful at a population level for cardiovascular outcomes, but most of the BP benefit for any individual is going to come from the weight loss itself.
The OP's extra ~6 mmHg beyond the predicted drop fits within that range, especially considering reduced sodium intake (common with reduced food volume) and increased physical activity are likely confounders.
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