The meta-analysis of 32 Phase III randomized controlled trials involving 43,618 adults demonstrates that GLP-1 receptor agonists and multi-hormone receptor modulators produce a placebo-adjusted systolic blood pressure drop of 5.2 mmHg alongside 10.9% weight loss, with 77% of BP variance tied directly to the degree of weight reduction (0.34 mmHg per 1% lost). This large-scale synthesis of RCT data, far exceeding typical observational cohorts in rigor, confirms clinically meaningful effects even after adjusting for diabetes status, baseline BMI, and trial duration. Yet the original coverage underplays the remaining 23% of BP reduction attributable to weight-independent mechanisms such as direct vascular relaxation, improved renal sodium handling, and blunted sympathetic signaling. These pathways align with findings from the SELECT trial (NEJM 2023; n=17,604), where semaglutide cut major cardiovascular events by 20% with only modest mediation through weight loss alone. The analysis also overlooks agent-specific heterogeneity: tirzepatide's dual GIP/GLP-1 action may amplify both weight-dependent and endothelial benefits beyond single-receptor agonists. Together these data position GLP-1 therapies as foundational cardiometabolic agents rather than adjunctive weight-loss tools, with implications for revising hypertension guidelines in obesity.