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Heart rate: the escalation transient This is the two-instruments effect covered above: a modest chronic mean, a larger escalation peak, and a lean, East-Asian tail. Blood pressure moves the other way, down about 6 to 9 mmHg systolic, so the heart-rate rise is not a blood-pressure effect, and it reverses when the drug stops. Low blood sugar tracks the insulin background On its own tirzepatide is insulin-sparing and rarely causes low blood sugar