Key result
Subacute oral metformin reduced postprandial falls in systolic blood pressure (P=0.0002) and postprandial hypotension events (P=0.035) in individuals with type 2 diabetes.
Why the study?
Individuals with type 2 diabetes have a high risk of postprandial hypotension, which increases the risk of falls and mortality, and the effects of oral metformin on postprandial blood pressure required evaluation.
Does oral metformin reduce postprandial decrease in systolic BP in individuals with type 2 diabetes?
RCT (n=16)
Double-blind
crossover
Does oral metformin reduce postprandial decrease in systolic BP in individuals with type 2 diabetes?
p-value: p=0.0002
In individuals with type 2 diabetes, subacute administration of metformin attenuates postprandial hypotension, suggesting a novel cardiovascular benefit independent of its glucose-lowering effects.
Subacute metformin attenuates postprandial BP falls and cuts PPH events in T2D; extends evidence for its CV effects beyond glucose lowering.
Individuals with type 2 diabetes are at high risk of postprandial decrease in blood pressure (BP; i.e., a reduction in systolic BP of ≥20 mmHg, termed postprandial hypotension [PPH]), which increases the risk of falls and mortality. This study evaluated the effects of oral metformin on postprandial BP, heart rate (HR), glucagon-like peptide 1 (GLP-1), and gastric emptying (GE) in individuals with type 2 diabetes. We studied 16 patients (five women) before and after ingestion of a 75-g radiolabeled glucose drink, after both acute (30 min) and subacute (twice per day for 7 days) administration of metformin (850 mg) or placebo, according to a double-blind randomized crossover design. To quantify PPH events, 24-h ambulatory BP measurement after standardized meals (breakfast, lunch, and dinner) was used. The primary outcome was postprandial decrease in systolic BP. We found that acute administration of metformin did not affect BP, HR, plasma insulin, or GLP-1 levels but slowed GE (P < 0.001) and reduced glycemic response to oral glucose (P < 0.001). Subacute metformin increased HR (P = 0.029), slowed GE (P < 0.001), augmented plasma GLP-1 (P < 0.001) and reduced plasma glucose (P < 0.001) in response to oral glucose, without affecting plasma insulin. Moreover, subacute metformin reduced postprandial falls in systolic BP (P = 0.0002) and PPH events (P = 0.035) during ambulatory BP measurement. Preprandial BP was unaffected by metformin. To conclude, in type 2 diabetes, oral metformin attenuates the hypotensive response to meals, in association with stimulation of GLP-1 and slowing of GE, to reduce PPH. Article Highlights Postprandial hypotension (PPH) occurs frequently in type 2 diabetes. Metformin has cardiovascular effects independent of its glucose-lowering capacity, which may modulate the risk of PPH. We investigated the effects of metformin on postprandial blood pressure, including PPH events, heart rate, glucose, insulin, glucagon-like peptide 1 (GLP-1), and gastric emptying, in individuals with type 2 diabetes. Metformin attenuated postprandial decrease in blood pressure and reduced PPH events, in association with augmentation of plasma GLP-1, slowed gastric emptying, and increased heart rate, in type 2 diabetes. These findings establish novel cardiovascular effects of metformin that may mitigate the risk of PPH in type 2 diabetes.
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Quast et al. (2025) conducted an RCT in type 2 diabetes (n=16). Metformin vs. Placebo was evaluated on Postprandial decrease in systolic BP (p=0.0002). Subacute oral metformin reduced postprandial falls in systolic blood pressure (P=0.0002) and postprandial hypotension events (P=0.035) in individuals with type 2 diabetes.
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