GLP-1RA, SGLT2i treatment reduces BP in patients with T2D

  • Hu M & al.
  • J Am Heart Assoc
  • 7 Apr 2020

  • curated by Miriam Tucker
  • Clinical Essentials
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Takeaway

  • Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT2is) significantly reduce BP in patients with type 2 diabetes (T2D).
  • With both drug classes, BP decrease was associated with weight reduction.

Why this matters

  • GLP-1RAs and SGLT2is improve cardiovascular outcomes, but what mediates their BP-lowering effects has not been elucidated.  

Study design

  • Systematic review, meta-analysis of 44 GLP-1RA (n=61,299) and 85 SGLT2i (n=40,874) trials comparing drug with placebo.
  • Funding: National Key Research and Development Program, China; National Natural Science Foundation, China.

Key results

  • With GLP-1RAs, significantly decreased (weighted mean differences):
    • Systolic BP (SBP) vs baseline:
      • −2.856 mmHg (P<.001>
    • Diastolic BP (DBP) vs baseline:
      • −0.898 mmHg (P<.001>
    • SBP vs placebo:
      • −1.724 mmHg (P<.001>
  • With SGLT2is, significantly decreased (weighted mean differences):
    • SBP vs baseline:
      • −4.331 mmHg (P<.001>
    • DBP vs baseline:
      • −2.279 mmHg (P<.001>
    • SBP vs placebo:
      • −3.612 mmHg (P<.001>
    • DBP vs placebo: 
      • −1.559 mmHg (P<.001>
  • With GLP-1RAs, associations between HbA1c reduction and SBP/DBP reduction were not significant after further adjustment for weight change.
  • After adjustments for age, sex, BMI, diabetes duration, and HbA1c change from baseline, weight reduction was positively associated with:
    • SBP and DBP reduction with GLP-1RA (both P<.001 and>
    • SBP reduction with SGLT2i (P=.001).

Limitations

  • Interstudy heterogeneity.
  • BP was not usually the primary endpoint.
  • Possible publication bias.