Efficacy of DPP-4 Inhibitors on Seated and Ambulatory Blood Pressure in Type 2 Diabetes Mellitus
Abstract
Background: Dipeptidyl peptidase-4 inhibitors (DPP-4i) are incretin-based agents for type 2 diabetes mellitus (T2DM) and might reduce blood pressure (BP). This study aims to assess their effects on seated- and ambulatory BP (ABP).
Methods: PubMed, Embase and the Cochrane Library were searched for randomised controlled trials reporting systolic BP (SBP), diastolic BP (DBP) or ABP. Placebo-controlled and active-controlled comparisons were analysed separately. Subgroup and meta-regression analysis were prespecified as exploratory. Risk of bias and certainty of evidence were assessed using the Cochrane tool and GRADE, respectively. The protocol was registered in PROSPERO (CRD42019138927).
Results: Sixty-seven publications comprising 79 studies were included and only 11 studies were rated as high quality. Compared with placebo, DPP-4i produced a small reduction in seated SBP (-1.69 mmHg; 95% CI, -2.78 to -0.61, I 2 = 18%; 26 studies; n = 2587 participants). In the exploratory renin-angiotensin-aldosterone system inhibitors (RAASi) co-administration subgroup, seated SBP was lower by -1.60 mmHg (95% CI, -3.04 to -0.16; I 2 = 57%; 39 studies; n = 4064 participants), with moderate heterogeneity. In participants with baseline HbA1c ≤ 7.5%, the DBP estimate was borderline (-0.85 mmHg; 95% CI, -1.71 to 0.00; 22 studies; n = 1655 participants) and was not considered robust evidence of benefit. High-quality studies showed no detectable changes in seated SBP or DBP. ABP analyses showed no…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 4,064 participants or records.
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