Effects of Oral and Non-Insulin Injectable Antidiabetic Treatment in Hypertension: A Systematic Review

Title:Effects of Oral and Non-Insulin Injectable Antidiabetic Treatment in Hypertension: A Systematic Review

Volume: 23 Issue: 25

Author(s): Vasiliki Katsi*, Georgios Georgiopoulos*, Georgia Vogiatzi, Dimitrios Oikonomou, Maria Megapanou, John Skoumas, Charalampos Vlachopoulos, Petros Nihoyannopoulos and Dimitris Tousoulis

Affiliation:

• ‘Hippokration' General Hospital, 114, Vas. Sofias Street, PC 11528, Athens,Greece

• ‘Hippokration' General Hospital, 114, Vas. Sofias Street, PC 11528, Athens,Greece

Keywords: Diabetes mellitus, antidiabetics, hypertension, blood pressure, hemodynamic impact, Thiazolidinediones, cardiovascular events.

Abstract: Background: Diabetes mellitus type 2 (T2DM) often co-exists with hypertension, and this aggregation of co-morbidities amplifies the risk for future cardiovascular events. Therefore, it appears crucial to understand the essence of choosing oral and non-insulin injectable anti-diabetic drugs (ADs) with a favorable hemodynamic impact that could partially attenuate the increased baseline cardiovascular risk.

Objective: We sought to evaluate the effect of ADs on blood pressure (BP) indices and to assess the potential role of certain ADs towards hypertension treatment.

Method: We performed a systematic review of the literature searching MEDLINE via Pubmed for all human studies implementing ADs, either individually or in combinations.

Results: Metformin was found to reduce BP in small cohorts but failed to confirm its beneficial effect in a metaanalysis of 41 studies. Thiazolidinediones are associated with BP lowering but are contraindicated in patients with heart failure. Sulfonylureas, on the other hand, may increase BP, while a-glucosidase inhibitors, DPP-4 inhibitors, and SGLT2 inhibitors activate favorable pathophysiologic mechanisms serving as potential BP lowering agents. Relevant BP reduction was established for GLP-1 Ras in most clinical trials.

Conclusion: The favorable hemodynamic impact of certain classes of ADs might provide synergistic or incremental therapeutic benefits in high-risk patients suffering from both T2DM and hypertension. Additional randomized trials designed under the hypothesis of the emerging beneficial hemodynamic effect of ADs are expected to provide more robust evidence and to guide the optimization of combined treatment strategies in this challenging group of patients.

Cite this article as:

Katsi Vasiliki*, Georgiopoulos Georgios *, Vogiatzi Georgia , Oikonomou Dimitrios, Megapanou Maria , Skoumas John , Vlachopoulos Charalampos, Nihoyannopoulos Petros and Tousoulis Dimitris , Effects of Oral and Non-Insulin Injectable Antidiabetic Treatment in Hypertension: A Systematic Review, Current Pharmaceutical Design 2017; 23 (25) . https://dx.doi.org/10.2174/1381612823666170519144841