利拉鲁肽对血压的影响：利拉鲁肽随机对照试验的荟萃分析

Effect of liraglutide on blood pressure: a meta-analysis of liraglutide randomized controlled trials.

作者信息

Zhao Xu, Huang Kun, Zheng Meijie, Duan Junting

机构信息

Civil Aviation General Hospital, Peking University, Beijing, China.

Endocrinology Department, Civil Aviation General Hospital, Chaoyang Road, Beijing, China.

出版信息

BMC Endocr Disord. 2019 Jan 7;19(1):4. doi: 10.1186/s12902-018-0332-5.

BACKGROUND

Several clinical trials have studied the effects of glucagon-like peptide-1 receptor agonists (GLP-1RAs) on glycometabolism and cardiovascular risk factors since they were identified. Because of their cardiovascular benefits and efficacy in lowering glucose, GLP-1RAs are becoming increasingly important in clinical therapy for patients with or without pathoglycaemia. The aim of this study was to assess the effect of the GLP-1RA liraglutide on blood pressure based on randomised controlled trials (RCTs).

METHODS

We searched PubMed for RCTs published from 2009 to 2018 comparing the effect of liraglutide on blood pressure with that of placebo in individuals with or without pathoglycaemia. RCTs in humans that included data describing blood pressure changes from baseline to the end of the trial were selected for inclusion in the meta-analysis.

RESULTS

A total of 18 RCTs that enrolled 7616 individuals in the liraglutide group and 6046 individuals in the control group were included in this meta-analysis. Compared with placebo, liraglutide reduced systolic blood pressure (SBP) by 3.18 mmHg (95% CI -4.32, - 2.05), P < 0.00001, but had no significant effect on diastolic blood pressure (DBP). Subgroup analysis showed that the degree of reduction in SBP was associated with the dose of liraglutide but that significance disappeared when the intervention lasted over 1 year. Liraglutide 3.0 mg/d significantly reduced DBP by 1.46 mmHg (95% CI -2.61, 0.32), P = 0.01, but liraglutide 1.8 mg/d slightly increased DBP by 0.47 mmHg (95% CI 0.11, 0.83), P = 0.01, compared with placebo.

CONCLUSIONS

This meta-analysis demonstrated that liraglutide significantly reduced SBP in individuals with or without pathoglycaemia compared with placebo, but the difference was no longer significant when the intervention lasted over 1 year. Moreover, the effect of liraglutide on blood pressure is associated with the dose. This finding may provide additional evidence for cardiovascular protection.

背景

自胰高血糖素样肽-1受体激动剂（GLP-1RAs）被发现以来，多项临床试验研究了其对糖代谢及心血管危险因素的影响。由于GLP-1RAs具有心血管益处且能有效降低血糖，在有或无血糖异常的患者临床治疗中变得日益重要。本研究旨在基于随机对照试验（RCTs）评估GLP-1RA利拉鲁肽对血压的影响。

方法

我们在PubMed上检索了2009年至2018年发表的RCTs，比较利拉鲁肽对有或无血糖异常个体血压的影响与安慰剂的差异。纳入在人类中进行的、包含从基线到试验结束血压变化数据的RCTs以进行荟萃分析。

结果

本荟萃分析共纳入18项RCTs，利拉鲁肽组7616例个体，对照组6046例个体。与安慰剂相比，利拉鲁肽使收缩压（SBP）降低3.18 mmHg（95%CI -4.32，-2.05），P<0.00001，但对舒张压（DBP）无显著影响。亚组分析显示，SBP降低程度与利拉鲁肽剂量相关，但干预持续超过1年时该显著性消失。与安慰剂相比，利拉鲁肽3.0 mg/d使DBP显著降低1.46 mmHg（95%CI -2.61，0.32），P = 0.01，但利拉鲁肽1.8 mg/d使DBP轻微升高0.47 mmHg（95%CI 0.11，0.83），P = 0.01。