The effect of semaglutide on blood pressure in patients with type-2 diabetes: a systematic review and meta-analysis

Abstract

Objective To evaluate the blood pressure (BP) lowering ability of semaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1 RA), in individuals with type-2 diabetes (T2D). Methods Randomized controlled trials (RCTs) comparing subcutaneous or oral semaglutide with placebo or other antihyperglycemic agents (AHAs) in T2D patients were identified by searching PubMed, Embase, Web of Science, ClinicalTrials.gov and Cochrane Library. These screened studies included the outcomes of interest: systolic and/or diastolic BP. Weighted mean differences (WMDs) and 95 % confidence intervals (CIs) were used to present the meta-analysis results. Pooled and sensitivity analyses were performed, and the risk of bias was evaluated. Results Twenty-nine RCTs with a total of 26985 participants were recruited in the final analysis. The WMD in change from baseline in systolic BP (SBP) of semaglutide versus placebo or other AHAs was −2.31 mmHg (95% CI: −3.11 to −1.51), while that for diastolic BP (DBP) was 0.09 mmHg (95% CI: −0.16 to 0.33). It also reduced glycated hemoglobin A1c (HbA1c) by 0.75% (95% CI: −0.92 to −0.58) and body weight loss by 2.80 kg (95% CI: −3.51 to −2.08). The reduction in SBP was similar for subcutaneous and oral administration of semaglutide, with −2.36 (95% CI: −3.38 to −1.35) and −2.50 (95% CI: −3.48 to −1.53), respectively. Conclusions In T2D, SBP decreased significantly in the semaglutide group compared with placebo or other active controls. According to the efficacy results from this meta-analysis, subcutaneous and oral semaglutide have similar SBP-reducing effects. Therefore, the treatment of T2D patients with subcutaneous semaglutide or oral preparations is beneficial for reducing SBP.

Adipocentric origin of the common cardiometabolic complications of obesity in the young up to the very old: pathophysiology and new therapeutic opportunities

“…Real-world data is emerging on its safety and efficacy in lowering glycated hemoglobin, BMI, and BP ( 118 ). Oral semaglutide at 14 mg showed a similar BP lowering of 2 mmHg as subcutaneous semaglutide at 1 mg, an amount of reduction that can already justify a reduction in CV events and mortality ( 119 ). Also, after 6 months of treatment, it reduced fatty liver index and VAT, preserving fat-free and skeletal muscle mass, evaluated with bioimpedentiometry ( 120 ).…”

“…Also, after 6 months of treatment, it reduced fatty liver index and VAT, preserving fat-free and skeletal muscle mass, evaluated with bioimpedentiometry ( 120 ). Thanks to their weight loss properties, which involve all the body's adipose tissue deposits ( 119 ), GLP1-RA improves all CV risk factors, such as BP and lipid profile ( 121 ). A novel, potent preventive approach to CV disease will be based on a substantial weight loss strategy achievable only when a GLP1-RA is associated with lifestyle modifications.…”

Transforming Diabetes Care: The Molecular Pathways through Which GLP1-RAs Impact the Kidneys in Diabetic Kidney Disease

“…Recent meta-analysis suggests that semaglutide, a GLP-1 receptor agonist, significantly lowers systolic blood pressure (SBP) in individuals with T2D, independent of its blood glucose-lowering effects. Despite these known benefits, it remains unclear whether semaglutide can also regulate the dysregulation of blood pressure’s circadian rhythm, and what its long-term effects are [ 75 ].…”