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Patoulias D, Boulmpou A, Papadopoulos CE, Siskos F, Stavropoulos K, Tranidou A, Mouselimis D, Bakatselos S, Damianidis G, Doumas M. The effect of glucagon-like peptide-1 receptor agonists on 24-hour ambulatory blood pressure: a meta-analysis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Hypertension augments overall cardiovascular risk in patients with type 2 diabetes mellitus (T2DM), constituting a major additional burden for diabetic subjects; however, control rates of hypertension remain suboptimal. Glucagon-like peptide-1 receptor agonists (GLP-1RAs), second-line treatment option for diabetics, have revolutionized the field of T2DM therapeutic management due to their pleiotropic effects, while they seem to hold multiple cardiovascular benefits. A few randomized controlled trials (RCTs) evaluated the effect of GLP-1RAs on ambulatory blood pressure (ABP). Ambulatory blood pressure monitoring (ABPM) provides a better method to predict long-term cardiovascular outcomes than office blood pressure.
Purpose
We sought to determine the effect of GLP-1RAs on ABPM, pooling data from relevant randomized controlled trials (RCTs).
Methods
We searched 2 major electronic databases, namely PubMed and Cochrane/CENTRAL, along with grey literature sources, for RCTs assessing the effect of various GLP-1RAs on ABP in patients with T2DM.
Results
After screening of the potentially eligible records, 7 RCTs were finally included in our meta-analysis (4 parallel-group and 3 cross-over). GLP-1RA treatment compared to placebo or active control resulted in a nonsignificant decrease in 24-h systolic blood pressure (MD=−1.57 mm Hg, 95% CI: −4.12 to 0.98, I2=63%) (Figure 1) and in 24-h diastolic blood pressure (MD=1.28 mmHg, 95% CI: −0.31 to 2.87, I2=49%) (Figure 2). No subgroup differences between the various GLP-1RAs were identified. More specifically, it was demonstrated that liraglutide once daily produced a non-significant decrease in 24-h systolic blood pressure (MD=−1.43 mm Hg, 95% CI: −5.24 to 2.38, I2=72%) and a non-significant increase in 24-h diastolic blood pressure (MD=1.47 mm Hg, 95% CI: −1.12 to 4.05, I2=61%), while data concerning the effect of once weekly dulaglutide and twice daily exenatide on ABPM were pooled from one RCT respectively (Figures 1, 2).
Conclusions
Antidiabetic treatment with GLP-1RAs does not influence either systolic or diastolic ABP in patients with T2DM.
Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
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Affiliation(s)
- D Patoulias
- Hippokration General Hospital of Thessaloniki, Second Propedeutic Department of Internal Medicine, Thessaloniki, Greece
| | - A Boulmpou
- Hippokration General Hospital of Thessaloniki, Third Department of Cardiology, Thessaloniki, Greece
| | - C E Papadopoulos
- Hippokration General Hospital of Thessaloniki, Third Department of Cardiology, Thessaloniki, Greece
| | - F Siskos
- Hippokration General Hospital of Thessaloniki, Second Propedeutic Department of Internal Medicine, Thessaloniki, Greece
| | - K Stavropoulos
- Hippokration General Hospital of Thessaloniki, Second Propedeutic Department of Internal Medicine, Thessaloniki, Greece
| | - A Tranidou
- Hippokration General Hospital of Thessaloniki, Fourth Department of Internal Medicine, Thessaloniki, Greece
| | - D Mouselimis
- Hippokration General Hospital of Thessaloniki, Second Propedeutic Department of Internal Medicine, Thessaloniki, Greece
| | - S Bakatselos
- Hippokration General Hospital of Thessaloniki, First Department of Internal Medicine, Thessaloniki, Greece
| | - G Damianidis
- Hippokration General Hospital of Thessaloniki, First Department of Internal Medicine, Thessaloniki, Greece
| | - M Doumas
- Hippokration General Hospital of Thessaloniki, Second Propedeutic Department of Internal Medicine, Thessaloniki, Greece
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Patoulias D, Boulmpou A, Imprialos K, Stavropoulos K, Papadopoulos C, Doumas M. Meta-analysis evaluating the risk of respiratory tract infections and acute respiratory distress syndrome with glucagon-like peptide-1 receptor agonists in cardiovascular outcome trials: Useful implications for the COVID-19 pandemic. Rev Clin Esp 2021; 222:229-232. [PMID: 34167924 PMCID: PMC8179096 DOI: 10.1016/j.rceng.2021.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 04/13/2021] [Indexed: 01/04/2023]
Abstract
Patients with type 2 diabetes mellitus (T2DM) are at increased risk for severe coronavirus disease 2019 (COVID-19) and related mortality. Glucagon-like peptide-1 receptor agonists (GLP-1-RAs) have significant cardiovascular and renal benefits for patients with T2DM and related comorbidities. Their anti-inflammatory properties could be beneficial in these patients. This work provides less-biased estimates regarding the risk for respiratory tract infections and acute respiratory distress syndrome by performing the first significant meta-analysis of cardiovascular outcome trials in the literature. Notably, GLP-1-RAs do not seem to increase the risk for respiratory tract infection, pneumonia, or acute respiratory distress syndrome in patients with T2DM and cardiovascular comorbidities.
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Affiliation(s)
- D Patoulias
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, General Hospital "Hippokration", Thessaloniki, Greece.
| | - A Boulmpou
- Third Department of Cardiology, Aristotle University of Thessaloniki, General Hospital "Hippokration", Thessaloniki, Greece
| | - K Imprialos
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, General Hospital "Hippokration", Thessaloniki, Greece
| | - K Stavropoulos
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, General Hospital "Hippokration", Thessaloniki, Greece
| | - C Papadopoulos
- Third Department of Cardiology, Aristotle University of Thessaloniki, General Hospital "Hippokration", Thessaloniki, Greece
| | - M Doumas
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, General Hospital "Hippokration", Thessaloniki, Greece; Veterans Affairs Medical Center, George Washington University, Washington, District of Columbia, Columbia, United States
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Patoulias D, Boulmpou A, Imprialos K, Stavropoulos K, Papadopoulos C, Doumas M. [Meta-analysis evaluating the risk of respiratory tract infections and acute respiratory distress syndrome with glucagon-like peptide-1 receptor agonists in cardiovascular outcome trials: useful implications for the COVID-19 pandemic]. Rev Clin Esp 2021; 222:229-232. [PMID: 33935292 PMCID: PMC8075844 DOI: 10.1016/j.rce.2021.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 04/13/2021] [Indexed: 02/06/2023]
Abstract
Patients with type 2 diabetes mellitus (T2DM) are at increased risk for severe coronavirus disease 2019 (COVID-19) and related mortality. Glucagon-like peptide-1 receptor agonists (GLP-1-RAs) have significant cardiovascular and renal benefits for patients with T2DM and related comorbidities. Their anti-inflammatory properties could be beneficial in these patients. This work provides less-biased estimates regarding the risk for respiratory tract infections and acute respiratory distress syndrome by performing the first significant meta-analysis of cardiovascular outcome trials in the literature. Notably, GLP-1-RAs do not seem to increase the risk for respiratory tract infection, pneumonia, or acute respiratory distress syndrome in patients with T2DM and cardiovascular comorbidities.
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Affiliation(s)
- D Patoulias
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, General Hospital "Hippokration", Thessaloniki, Grecia
| | - A Boulmpou
- Third Department of Cardiology, Aristotle University of Thessaloniki, General Hospital "Hippokration", Thessaloniki, Grecia
| | - K Imprialos
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, General Hospital "Hippokration", Thessaloniki, Grecia
| | - K Stavropoulos
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, General Hospital "Hippokration", Thessaloniki, Grecia
| | - C Papadopoulos
- Third Department of Cardiology, Aristotle University of Thessaloniki, General Hospital "Hippokration", Thessaloniki, Grecia
| | - M Doumas
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, General Hospital "Hippokration", Thessaloniki, Grecia.,Veterans Affairs Medical Center, George Washington University, Washington, District of Columbia, Columbia, Estados Unidos
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Patoulias D, Katsimardou A, Kalogirou MS, Zografou I, Toumpourleka M, Imprialos K, Stavropoulos K, Stergiou I, Papadopoulos C, Doumas M. Glucagon-like peptide-1 receptor agonists or sodium-glucose cotransporter-2 inhibitors as add-on therapy for patients with type 2 diabetes? A systematic review and meta-analysis of surrogate metabolic endpoints. Diabetes Metab 2020; 46:272-279. [PMID: 32437914 DOI: 10.1016/j.diabet.2020.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/04/2020] [Accepted: 04/19/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVE As sodium-glucose cotransporter-2 inhibitors (SGLT-2is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) are second-line treatment options in type 2 diabetes mellitus (T2DM), our study sought to provide precise effect estimates regarding the role of GLP-1RAs vs SGLT-2is as add-on treatments in patients uncontrolled by metformin monotherapy. RESEARCH DESIGN AND METHODS PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL) and 'grey literature' were searched from their inception up to December 2019 for randomized controlled trials (RCTs) with durations≥12weeks to evaluate the safety and efficacy of adding a GLP-1RA vs an SGLT-2i in patients with T2DM. RESULTS Three eligible RCTs were identified. Administration of GLP-1RAs vs SGLT-2is resulted in significant decreases in HbA1c with no significant impact on either body weight or fasting plasma glucose. GLP-1RA treatment led to a significant increase in odds for achieving an HbA1c<7% compared with SGLT-2is, whereas no difference was detected in body weight reductions of>5%. Significantly greater risk for any hypoglycaemia, nausea and diarrhoea, and lower risk for genital infections, was also observed with GLP-1RAs, while no differences regarding severe hypoglycaemia, treatment discontinuation and impact on blood pressure levels were identified. No other major safety issues arose. CONCLUSION Our meta-analysis suggests that GLP-1RAs provide better glycaemic effects than SGLT-2is in patients with T2DM uncontrolled by metformin, albeit while increasing risk for hypoglycaemia and gastrointestinal adverse events.
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Affiliation(s)
- D Patoulias
- Second Propaedeutic Department of Internal Medicine, General Hospital Ippokrateio, Aristotle University of Thessaloniki, Konstantinoupoleos 49, 54642 Thessaloniki, Greece.
| | - A Katsimardou
- Second Propaedeutic Department of Internal Medicine, General Hospital Ippokrateio, Aristotle University of Thessaloniki, Konstantinoupoleos 49, 54642 Thessaloniki, Greece
| | - M-S Kalogirou
- Second Propaedeutic Department of Internal Medicine, General Hospital Ippokrateio, Aristotle University of Thessaloniki, Konstantinoupoleos 49, 54642 Thessaloniki, Greece
| | - I Zografou
- Second Propaedeutic Department of Internal Medicine, General Hospital Ippokrateio, Aristotle University of Thessaloniki, Konstantinoupoleos 49, 54642 Thessaloniki, Greece
| | - M Toumpourleka
- Second Propaedeutic Department of Internal Medicine, General Hospital Ippokrateio, Aristotle University of Thessaloniki, Konstantinoupoleos 49, 54642 Thessaloniki, Greece
| | - K Imprialos
- Second Propaedeutic Department of Internal Medicine, General Hospital Ippokrateio, Aristotle University of Thessaloniki, Konstantinoupoleos 49, 54642 Thessaloniki, Greece
| | - K Stavropoulos
- Second Propaedeutic Department of Internal Medicine, General Hospital Ippokrateio, Aristotle University of Thessaloniki, Konstantinoupoleos 49, 54642 Thessaloniki, Greece
| | - I Stergiou
- Diabetes Outpatient Department, General Hospital G. Gennimatas, Thessaloniki, Greece
| | - C Papadopoulos
- Third Department of Cardiology, General Hospital Ippokrateio, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - M Doumas
- Second Propaedeutic Department of Internal Medicine, General Hospital Ippokrateio, Aristotle University of Thessaloniki, Konstantinoupoleos 49, 54642 Thessaloniki, Greece; VAMC and George Washington University, Washington, DC, USA
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Stavropoulos K, Imprialos K, Boutari C, Papadopoulos N, Dimakopoulou A, Georgianou E, Binas A, Sachinidis A, Stavropoulos N, Petidis K, Doumas M. [PP.23.12] OUT-OF-OFFICE BLOOD PRESSURE MEASUREMENT IN PATIENTS WITH RESISTANT HYPERTENSION IN EVERYDAY CLINICAL PRACTICE. J Hypertens 2016. [DOI: 10.1097/01.hjh.0000492083.56615.7b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Previous studies of clinical populations and normal children have suggested that the efficiency of callosal transfer correlates with the ability to sustain attention. The purpose of the present study was to determine whether the same might be true for normal adults. Subjects were 42 right-handed adults. The efficiency of the transfer via the anterior callosum was assessed on a bimanual coordination task. The efficiency of the posterior callosum was measured on a tachistoscopic task that required subjects to compare two lines when both were presented either to the same visual field or to opposite visual fields. Sustained attention was measured on a vigilance task in which the time between target presentations (ISI) was varied. Performance on the bimanual task correlated with the ability to sustain attention over the entire 20 min of the vigilance task. The efficiency of the posterior callosum was related to the ability to detect targets that occurred after relatively long ISIs.
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Affiliation(s)
- L Rueckert
- Department of Psychology, Northeastern Illinois University, Chicago, IL 60625, USA.
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Abstract
Respiratory drive in a patient with central alveolar hypoventilation was assessed by mouth occlusion pressure method. Respiratory drive was almost abolished in this patient.
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