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META-ANALYSIS OF THE EFFECT OF DUAL GIP AND GLP-1 RECEPTOR AGONISTS ON BLOOD PRESSURE LEVELS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

Objective: Hypertension and type 2 diabetes mellitus (T2DM) are common co-morbidities, with hypertension being twice as frequent in patients with T2DM compared to those without. Blood pressure (BP) control is of utmost importance for subjects with T2DM, in order to minimize the risk for development of cardiovascular and chronic kidney disease. High on treatment BP levels also correlate with the incidence of major adverse cardiovascular outcomes and all-cause death. Recently, novel dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonists have been developed for patients with T2DM. Therefore, we sought to determine whether dual GIP and GLP-1 receptor agonists have a significant effect on BP in subjects with T2DM. Design and method: We searched PubMed and Cochrane Library databases for relevant published randomized controlled trials up to 13th November 2021. We assessed the change in office systolic BP (SBP) and diastolic BP (DBP) with dual GIP and GLP-1 receptor agonists compared to placebo or active comparator in subjects with T2DM. Results: We finally pooled data from 5 trials for a total of 5,060 patients with T2DM. We demonstrated that dual GIP/GLP-1 receptor agonists compared to control induced a significant decrease in SBP by 3.6 mm Hg (MD = -3.6, 95% CI; -5.54 to -1.65, I2 = 83%, p = 0.0003), along with a significant decrease in DBP by 1.29 mm Hg (MD = -1.29, 95% CI; -2.30 to -0.28, I2 = 74%, p = 0.01). Conclusions: Dual GIP/GLP-1 receptor agonists might provide a significant decrease, and thus a better control of BP in patients with T2DM. Whether this preliminary observation is translated into a significant cardiovascular benefit has to be further confirmed in well-designed trials, such as the forthcoming SURPASS-CVOT (NCT04255433). Moreover, the effects of dual agonists on out-of-office BP values need to be evaluated.