Ali Abraish, Siddiqui Asad Ali, Usman Muhammad Shariq, Shahid Izza, Khan Muhammad Shahzeb, Perswani Prinka
Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan.
Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Clin Obes. 2025 Aug;15(4):e70012. doi: 10.1111/cob.70012. Epub 2025 Apr 23.
The effect of glucagon-like peptide 1 receptor agonists (GLP-1RAs) on systolic blood pressure (SBP) in patients with obesity with or without diabetes remains unclear. The aim was to compare the effect of different drug-dose combinations of GLP-1RAs on SBP. The secondary aim was to assess whether changes in SBP with GLP-1RAs are associated with weight change. MEDLINE and Cochrane were searched until January 2022 for randomized control trials (RCTs) on patients with obesity, evaluating the impact of semaglutide, liraglutide, efpeglenatide, or exenatide on SBP. Separate analyses were done for trials with and without diabetes. Multivariate meta-regression assessed if SBP changes with GLP-1RA varied based on weight change or follow-up duration. Thirty-five RCTs were included. Follow-up duration ranged from 12 to 68 weeks for T2DM and 12-56 weeks for non-T2DM patients. GLP-1RAs significantly lowered SBP for all patients (MD = -3.14 [-3.60; -2.68]). Subgroup analysis showed a significantly greater difference in SBP reduction for patients without diabetes (-3.80 [-4.24; -3.37]) when compared with patients with diabetes (-2.13 [-3.27; -1.00]). Among patients with diabetes, liraglutide < 2 mg OD showed the greatest reduction in SBP (-3.78 [-6.27; -1.28]), while efpeglenatide ≤ 6 mg QW showed the greatest reduction in SBP (-6.00 [-9.89; -2.11]) in patients without diabetes. GLP-1RAs result in mild reductions in SBP in patients with obesity. The change in SBP varies only slightly by the drug-dose combination and appears to be related to the amount of weight loss.
胰高血糖素样肽-1受体激动剂（GLP-1RAs）对伴有或不伴有糖尿病的肥胖患者收缩压（SBP）的影响尚不清楚。目的是比较GLP-1RAs不同药物剂量组合对SBP的影响。次要目的是评估GLP-1RAs引起的SBP变化是否与体重变化相关。检索MEDLINE和Cochrane数据库至2022年1月，查找关于肥胖患者的随机对照试验（RCTs），评估司美格鲁肽、利拉鲁肽、依佩格列肽或艾塞那肽对SBP的影响。对有糖尿病和无糖尿病的试验分别进行分析。多变量meta回归评估SBP随GLP-1RA的变化是否因体重变化或随访时间而异。纳入了35项RCTs。2型糖尿病患者的随访时间为12至68周，非2型糖尿病患者为12至56周。GLP-1RAs使所有患者的SBP显著降低（MD = -3.14 [-3.60；-2.68]）。亚组分析显示，与糖尿病患者（-2.13 [-3.27；-1.00]）相比，无糖尿病患者的SBP降低差异显著更大（-3.80 [-4.24；-3.37]）。在糖尿病患者中，每日一次利拉鲁肽<2 mg时SBP降低最大（-3.78 [-6.27；-1.28]），而在无糖尿病患者中，每周一次依佩格列肽≤6 mg时SBP降低最大（-6.00 [-9.89；-2.11]）。GLP-1RAs可使肥胖患者的SBP轻度降低。SBP的变化仅因药物剂量组合略有不同，且似乎与体重减轻量有关。
