GLP‐1RA, SGLT2i confer benefits for BP, weight in diabetic patients

Treatment with glucagon‐like peptide‐1 receptor agonists (GLP‐1RAs) and sodium‐glucose cotransporter‐2 inhibitors (SGLT2is) yields significant blood pressure (BP) reductions, as driven by weight loss, in patients with type 2 diabetes mellitus (T2DM), according to the results of a meta-analysis.

Researchers searched multiple online databases for ≥4-week randomized controlled trials comparing the efficacy and safety of GLP‐1RA or SGLT2i with placebo or other antidiabetic agents in T2DM patients, with outcomes including changes in haemoglobin A1c (HbA1c), weight or BP.

The meta-analysis included 184 studies, of which 89 studies evaluated GLP‐1RA and 94 assessed SGLT2i treatment. One study compared the efficacy and safety of co-initiating both drug classes with either alone. The population comprised 61,299 individuals in the GLP‐1RA arm and 40,874 in the SGLT2i arm, with age ranging from 46.7 to 68.0 years and from 50.6 to 70.9 years, respectively.

Pooled data revealed that both GLP‐1RA and SGLT2i produced significant improvements from baseline in systolic BP (weighted mean difference [MD], −2.856 and −4.331 mm Hg, respectively; p<0.001) and diastolic BP (weighted MD, −0.898 and −2.279 mm Hg, respectively; p<0.001). For both drug classes, HbA1c control was not independently related to either systolic or diastolic BP reduction.

However, weight reduction with GLP‐1RA treatment was positively associated with systolic and diastolic BP reduction (p<0.001). With SGLT2i treatment, weight loss showed a significant association with only systolic BP reduction (p=0.001).

The present data indicate that weight loss contributes to the BP‐lowering effects of GLP‐1RA and SGLT2i, the researchers said. More research is needed to establish the mechanisms underlying the treatment-related reductions in BP and its potential impact on cardiovascular outcomes.