Glucagon‐like peptide‐1 receptor agonists modestly reduced blood pressure among patients with and without diabetes mellitus: A meta‐analysis and meta‐regression

Mar 20, 2024Diabetes, obesity & metabolism

Glucagon-like peptide-1 receptor drugs slightly lower blood pressure in people with and without diabetes

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Abstract

GLP-1 receptor agonists reduced systolic blood pressure (SBP) by an average of 3.40 mmHg for semaglutide compared to placebo.

Liraglutide and dulaglutide also showed significant reductions in SBP of 2.61 mmHg and 1.46 mmHg, respectively, compared to placebo.
Exenatide demonstrated a similar SBP reduction of 3.36 mmHg, with the effect increasing with longer treatment durations.
Diastolic blood pressure reduction was significant only in the exenatide group, with a mean difference of -0.94 mmHg.
Among semaglutide users, reductions in glycated hemoglobin and body mass index were directly related to the decrease in SBP.
The findings suggest that the blood pressure-lowering effect is likely indirect, linked to improvements in weight and glycemic control.

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AIM: The cardiovascular benefits provided by glucagon-like peptide-1 receptor agonists (GLP-1RAs) extend beyond weight reduction and glycaemic control. One possible mechanism may relate to blood pressure (BP) reduction. We aim to quantify the BP-lowering effects of GLP1-RAs.

METHODS: A comprehensive database search for placebo-controlled randomized controlled trials on GLP-1RA treatment was conducted until December 2023. Data extraction and quality assessment were carried out, employing a robust statistical analysis using a random effects model to determine outcomes with a mean difference (MD) in mmHg and 95% confidence intervals (CIs). The primary endpoint was the mean difference in systolic BP (SBP) and diastolic BP. Subgroup analyses and meta-regressions were done to account for covariates.

RESULTS: Compared with placebo, GLP-1RAs modestly reduced SBP [semaglutide: MD -3.40 (95% CI -4.22 to -2.59, p < .001); liraglutide: MD -2.61 (95% CI -3.48 to -1.74, p < .001); dulaglutide: MD -1.46 (95% CI -2.20 to -0.72, p < .001); and exenatide: MD -3.36 (95% CI -3.63 to -3.10, p < .001)]. This benefit consistently increased with longer treatment durations. Diastolic BP reduction was only significant in the exenatide group [MD -0.94 (95% CI -1.78 to -0.1), p = .03]. Among semaglutide cohorts, mean changes in glycated haemoglobin and mean changes in body mass index were directly associated with SBP reduction.

CONCLUSION: Patients on GLP-1RA experienced modest SBP lowering compared with placebo. This observed effect was associated with weight/body mass index reduction and better glycaemic control, which suggests that BP-lowering is an indirect effect of GLP-1RA and unlikely to be responsible for the benefits.

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Glucagon‐like peptide‐1 receptor agonists modestly reduced blood pressure among patients with and without diabetes mellitus: A meta‐analysis and meta‐regression

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