Posted Apr 19 , 2019 09:08 AM

Predictors and correlates of systolic blood pressure reduction with liraglutide treatment in patients with type 2 diabetes.

Wijkman MO, et al. Journal of Clinical Hypertension 2018;21:105

Institute Summary (excerpted from the Abstract):

Liraglutide is associated with blood pressure reduction in patients with type 2 diabetes. However, it is not known whether this blood pressure reduction can be predicted prior to treatment initiation, and to what extent it correlates with weight loss and with improved glycemic control during follow‐up. The authors analyzed data from a double‐blind, placebo‐controlled trial, in which 124 insulin‐treated patients with type 2 diabetes were randomized to liraglutide or placebo. They evaluated various baseline variables as potential predictors of systolic blood pressure (SBP) reduction and evaluated whether changes in SBP correlated with weight loss and with improved glycemic control. A greater reduction in SBP among liraglutide‐treated patients was predicted by higher baseline values of SBP and diastolic blood pressure, and by lower baseline values of mean glucose measured by continuous glucose monitoring (CGM) and serum fasting C‐peptide. The regression coefficients differed significantly between the liraglutide group and the placebo group only for diastolic blood pressure and mean CGM. During the trial period, SBP reduction correlated directly with change in body weight and BMI, but not with change in HbA1c.

Why is this important?

Their conclusion was that patients with lower mean CGM values at baseline responded to liraglutide with a larger reduction in SBP, and that improved HbA1c during follow‐up was not associated with reductions of SBP. These data suggest that some patients with type 2 diabetes may benefit from liraglutide in terms of weight and SBP reduction. While the fact that the GLP-1 agonists can influence blood pressure is not new, it is important to determine what variables correlate with the change in systolic blood pressure to determine the likelihood you might see lower SBP. The authors found that a larger SBP reduction by liraglutide was predicted by higher baseline values of DBP and by lower baseline mean CGM values, that a larger reduction in SBP during follow‐up was associated with weight loss and with BMI reduction, but not with HbA1c reduction. Importantly, some patients responded to liraglutide with SBP reduction without experiencing clinically significant improvements of HbA1c or body weight. Together with the recent analysis of predictors of weight reduction by liraglutide, the present study suggests that patients with better glycemic control may respond to liraglutide with greater weight and blood pressure reductions, whereas those with a higher HbA1c are more likely to respond with improved glycemic control.

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