Semaglutide, both oral and subcutaneous, significantly reduces systolic BP in diabetes patients

Across 29 randomized controlled trials (RCTs), semaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1 RA), was shown to notably reduce both body weight loss and glycated haemoglobin A1c (HbA1c), but no significant impact on diastolic blood pressure.

"In type 2 diabetes, SBP reduced significantly in the semaglutide group compared with placebo or other active controls," Wei Wu, Chun'an First People's Hospital (Zhejiang Provincial People's Hospital Chun'an Branch), Hangzhou, Zhejiang, China, and colleagues reported in the journal Endocrine.

Poor blood pressure control is common in T2D patients; hypertension occurs in about two-thirds of patients, making optimal BP lowering crucial for disease management. Semaglutide has glucose-lowering effects in a glucose-dependent manner and does not increase the risk of hypoglycemia. The agent has been shown to reduce weight, and HbA1c, and provide additional benefits, including kidney function improvement and BP regulation.

There is a lack of studies analyzing semaglutide's impact on blood pressure as a primary outcome. Therefore, the researchers aimed to evaluate the BP-lowering ability of semaglutide in individuals with type-2 diabetes.

For this purpose, the researchers identified RCTs comparing subcutaneous or oral semaglutide with placebo or other antihyperglycemic agents (AHAs) in T2D patients using online databases. These screened studies included the outcomes of interest: diastolic BP and/or systolic BP. Pooled and sensitivity analyses were performed, and the risk of bias was evaluated. Weighted mean differences (WMD) were used to present the meta-analysis results. The final analysis included twenty-nine RCTs with 26985 participants.

The researchers reported the following findings:

• The WMD change from baseline in systolic BP of semaglutide versus placebo or other AHAs was −2.31 mmHg, while that for diastolic BP was 0.09 mmHg.
• It also reduced glycated haemoglobin A1c (HbA1c) by 0.75% and body weight loss by 2.80 kg.
• The reduction in SBP was similar for subcutaneous and oral administration of semaglutide, with −2.36 and −2.50, respectively.

"Our analysis suggests that semaglutide, either subcutaneous or oral, can significantly lower SBP in T2D patients," the researchers wrote. "For T2D patients with hypertension, semaglutide's antihypertensive effect may be greater than 2.31 mmHg in this paper, but still there is a need to determine the real-world effect."

"Future studies to uncover the underlying blood pressure-lowering mechanisms of semaglutide will benefit more individuals with diabetes by increasing the understanding of these associations," they concluded.

Reference:

Wu, W., Tong, Hm., Li, Ys. et al. The effect of semaglutide on blood pressure in patients with type-2 diabetes: a systematic review and meta-analysis. Endocrine (2023). https://doi.org/10.1007/s12020-023-03636-9