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Web End = Curr Hypertens Rep (2016) 18: 16
DOI 10.1007/s11906-015-0621-6
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Web End = THERAPEUTIC TRIALS (M WEIR, SECTION EDITOR)
GLP-1 Agonists and Blood Pressure: A Review of the Evidence
Aditya Goud1,2 & Jixin Zhong1,2 & Matthew Peters1,2 & Robert D. Brook1,2 &
Sanjay Rajagopalan1,2
Published online: 23 January 2016# Springer Science+Business Media New York 2016
Abstract Type 2 diabetes mellitus (T2DM) is a major risk factor for cardiovascular disease. The presence of concomitant hypertension in diabetics is a major driver of excess cardiovascular risk. Glucagon-like peptide-1 receptor agonists (GLP-1a) act on numerous pathways that intersect glycemic, weight, and blood pressure (BP) control. BP-lowering effects have been observed in mouse models of hypertension with a variety of GLP-1a. Acute administration of GLP-1a in humans has been shown to no effects and sometimes increased BP in humans. Chronic administration of GLP-1a, however, reduces clinic systolic BP (2 mmHg) at least when evaluated as a secondary end point in glycemia-lowering studies while simultaneously increasing heart rate. BP lowering has not been consistently observed in two recent double-blind controlled clinical trials evaluating ambulatory BP as the primary end point. While a number of mechanisms including vascular, myocardial, renal, and central nervous system pathways have been suggested in animal studies, these mechanistic pathways have not been sufficiently detailed in humans and it is unclear if the same pathways are operational. Further studies need to be conducted to unravel the full spectrum
of effects of this drug class. An understanding of their effects on BP may help provide an explanation for the ability of GLP-1a to influence cardiovascular (CV) events in ongoing event-driven CV trials.
Keywords Glucagon-like peptide-1 agonist . Diabetes . Blood pressure . Cardiovascular disease . Atrial natriuretic peptide
Introduction
Type 2 diabetes mellitus (T2DM) is a major risk factor for the development of cardiovascular disease (CVD) and its attendant complications [1]. T2DM is typically associated with obesity and the metabolic syndrome phenotype, with a high prevalence of concomitant hypertension and dyslipidemia. The need for attaining glucose, blood pressure (BP), and lipid goals in the diabetic patient most often mandates multiple...