Journal of the American Heart AssociationApr 1, 2020

How Lowering Blood Sugar or Weight Affects Blood Pressure During Diabetes Treatment with GLP-1 and SGLT2 Medicines: A Combined Analysis

GLP-1 Therapies Weekly Brief ↗PubMed ↗DOI ↗

Updated Feb 23, 2026

Abstract

Treatment with GLP-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT2is) resulted in significant reductions in systolic and diastolic blood pressure in 184 trials.

GLP-1RAs led to a reduction in systolic blood pressure by 2.856 mm Hg and diastolic blood pressure by 0.898 mm Hg.
SGLT2is were associated with a reduction in systolic blood pressure by 4.331 mm Hg and diastolic blood pressure by 2.279 mm Hg.
Hemoglobin A1c reduction was not independently linked to changes in systolic or diastolic blood pressure for either drug class.
In GLP-1RA treatment, weight reduction was positively associated with both systolic and diastolic blood pressure reductions.
For SGLT2i treatment, weight loss was significantly associated with systolic blood pressure reduction, but not with diastolic blood pressure reduction.

Simplified

Background Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT2is) have shown their beneficial effects on cardiovascular outcomes and multiple cardiovascular risk factors, including hypertension. However, the mechanism of blood pressure (BP)-lowering effects of these agents has not been elucidated. This study aims to evaluate the effect of hemoglobin A1c reduction or body weight reduction with GLP-1RA treatment and SGLT2i treatment on BP changes in patients with type 2 diabetes mellitus. Methods and Results Studies were identified by a search of MEDLINE, EMBASE, and the Cochrane Central Register until June 2019. Meta-regression analysis was performed to evaluate the association between hemoglobin A1c reduction or body weight reduction and changes of BP. A total of 184 trials were included. Both GLP-1RA and SGLT2i led to significant reductions in systolic BP (weighted mean difference, -2.856 and -4.331 mm Hg, respectively;<0.001 for both) and diastolic BP (weighted mean difference, -0.898 and -2.279 mm Hg, respectively;<0.001 for both). For both drug classes, hemoglobin A1c reduction was not independently associated with systolic BP reduction or diastolic BP reduction. In GLP-1RA treatment, weight reduction was positively associated with systolic BP reduction and diastolic BP reduction (β=0.821 and β=0.287, respectively;<0.001 for both). In SGLT2i treatment, weight loss was significantly associated with systolic BP reduction (β=0.820;=0.001) but was not associated with diastolic BP reduction. Conclusions Treatment with GLP-1RA and SGLT2i led to significant reductions in BP in patients with type 2 diabetes mellitus. Weight reduction was significantly and independently associated with BP reductions in GLP-1RA treatment and SGLT2i treatment. P P P P

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How Lowering Blood Sugar or Weight Affects Blood Pressure During Diabetes Treatment with GLP-1 and SGLT2 Medicines: A Combined Analysis

Abstract

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