Title: Blood Pressure Reduction in GLP-1 RA Users in a Family Medicine Clinic
Authors: David Mercer, PharmD; Julia Mesawich, PharmD; Tiffaney Threatt, PharmD, CDCES, BC-ADM, FADCES
Practice Site: Prisma Health-Upstate
Background:
The prevalence of hypertension has surged, with the 2017-2018 NHANES survey indicating that 45.4% of US adults over the age of 18 years old have hypertension. Hypertension is a common complication of type 2 diabetes mellitus (T2DM), and approximately 70% of those with T2DM have hypertension. Therefore, a therapy that simultaneously lowers blood pressure and blood glucose could be an ideal treatment option for patients who require comprehensive management of these conditions. Incretin-based therapy is an emerging treatment for T2DM and obesity that can stimulate insulin secretion, improve insulin resistance, and reduce body weight. While some meta-analyses have shown that patients on GLP-1 RAs experience modest blood pressure lowering, there have not been any studies that look at this as a primary endpoint. The primary objective was to determine the blood pressure lowering effect of GLP-1 RAs on systolic and diastolic blood pressure in adults within 1 year of starting a GLP-1 RA.
Methods:
This study was an observational, retrospective pre-post study of approximately 100 patients completed at Travelers Rest Family Medicine in South Carolina. Patients were identified for inclusion if they were prescribed a GLP-1 RA between 12/01/2020 and 06/01/2021, with this date range chosen to give sufficient sample size and to minimize gaps in therapy due to medication shortages.
GLP-1 RA use was defined as at least two prescriptions sent for the same GLP-1 RA, authorized on different dates, as reported within the electronic medical record. Participants were excluded if they did not have enough refills of the GLP-1 RA to last a 12-month period. Participants were also excluded if they were started on a GLP-1 RA and a blood pressure lowering medication at the same visit, if they underwent bariatric surgery during the timeframe, or became pregnant during the timeframe.
Clinic-measured systolic and diastolic blood pressures from baseline to one year after the initiation of GLP-1 RA therapy were collected to assess the primary endpoint. The secondary analysis includes an evaluation of the change in systolic and diastolic blood pressure from baseline to month 9-12 within the population with a diagnosis of hypertension, change in systolic and diastolic blood pressure stratified by GLP-1 RA use, and an evaluation of the change in weight from baseline to month 9-12 after GLP-1 RA initiation.
Results:
A total of 77 participants were evaluated for change in blood pressure from baseline to month 9-12 after GLP-1 RA initiation. In looking at baseline characteristics, 100% of the participants had a diagnosis of type 2 diabetes, and 80.52% had a diagnosis of hypertension. Most participants started on semaglutide injection (33.77%) or dulaglutide injection (36.36%). For the primary outcome, there was a statistically significant change in SBP from baseline to 9-12 months after GLP-1 RA initiation with a p value of <0.001. There was no statistically significant change in diastolic blood pressure within the study timeframe.
Within specific GLP-1 RA medications, the only medication that had a statistically significant change in blood pressure from baseline to month 9-12 was dulaglutide injection. The lack of statistical significance within other groups may have been due to the small sample sizes. There was not a statistically significant change in weight from baseline to month 9-12 within the population. This may have been due to many not reaching maximum doses of GLP-1 RA agent.
Conclusions:
From baseline to month 9-12, GLP-1 receptor agonists lowered blood pressure with statistical significance. When looking at the individual GLP-1 RAs, only dulaglutide injection had statistically significant blood pressure lowering effects. In conclusion, in someone with hypertension and another compelling indication, GLP-1 RAs may be a good option for comprehensive management of comorbidities.
Contact:
julia.mesawich@prismahealth.org
