Abstract Body (Do not enter title and authors here): Introduction: Although glucagon-like peptide-1 receptor agonists have been shown to reduce BP and major cardiovascular adverse events (MACE), little is known about whether the benefits of these therapies vary in individuals with hypertension (HT) or across the spectrum of BP categories.

Research Question and Aim: To evaluate the effect of once-weekly semaglutide 2.4 mg vs placebo on cardiovascular (CV) outcomes by baseline BP categories in SELECT.

Methods: SELECT was a double-blind, randomized, placebo-controlled trial that included patients aged ≥45 years with preexisting CV disease and BMI ≥27 kg/m² without diabetes. Patients received once-weekly semaglutide 2.4 mg or placebo; the primary endpoint was time to first MACE analyzed with a Cox proportional hazards model with semaglutide and placebo as fixed factors according to baseline BP categories.

Results: Among 17,604 randomized patients, 14,392 (82%) had a history of HT. Patients with history of HT were older and more likely female, with a higher BMI, lower eGFR, and higher UACR. A higher proportion presented with atrial fibrillation, obstructive sleep apnea, and heart failure NYHA class II/III, but fewer underwent coronary revascularization (Table). Patients with HT who received placebo had a higher incidence rate of MACE vs semaglutide (2.6 vs 2.1 per 100 patient-years, respectively). Semaglutide generally exhibited consistent benefits for CV outcomes regardless of history of HT or baseline BP categories (Figure). Compared with placebo, semaglutide significantly and consistently reduced systolic BP (SBP) across BP categories (normal, −2.9 [95% CI−4.0; −1.9]; elevated BP, −2.8 [−4.0; −1.6]; stage 1, −3.4: [−4.1; −2.6]; stage 2, −3.7 [− 4.4; −2.9]).

Conclusions: HT is highly prevalent in people with overweight or obesity and atherosclerotic CV disease without diabetes and is associated with increased MACE. Semaglutide led to consistent reductions in MACE and lowered SBP irrespective of baseline BP category.