Effect of glucagon‐like peptide 1 receptor agonists on systolic blood pressure in patients with obesity, with or without diabetes: A systematic review and network meta‐analysis

Summary 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.