Dipeptidyl peptidase-4 inhibitors produced a small reduction in seated systolic blood pressure compared with placebo (MD -1.69 mmHg; 95% CI -2.78 to -0.61), though clinical relevance is uncertain.
Meta-Analysis
Do DPP-4 inhibitors reduce seated and ambulatory blood pressure in patients with type 2 diabetes mellitus?
DPP-4 inhibitors produce a clinically modest and uncertain reduction in seated systolic blood pressure, not supporting their use as a primary blood pressure-lowering therapy.
Mean Difference: -1.69 (95% CI -2.78–-0.61)
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 detectable differences based on only three publications (four studies). Estimates were exploratory and underpowered and certainty was low to very low. Conclusions DPP‐4i might produce a small reduction in seated SBP compared with placebo, but the magnitude was modest and the clinical relevance for individual patients was uncertain. Evidence for DBP and ABP effects was inconclusive. These findings did not support the use of DPP‐4i as BP‐lowering therapy, and adequately powered trials with standardised BP protocols are needed.
Zhao et al. (Wed,) conducted a meta-analysis in Type 2 Diabetes Mellitus. Dipeptidyl peptidase-4 inhibitors (DPP-4i) vs. Placebo was evaluated on Seated systolic blood pressure (SBP) (MD -1.69 mmHg, 95% CI -2.78 to -0.61). Dipeptidyl peptidase-4 inhibitors produced a small reduction in seated systolic blood pressure compared with placebo (MD -1.69 mmHg; 95% CI -2.78 to -0.61), though clinical relevance is uncertain.