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GLP-1对2型糖尿病患者血压、心率和高血压的影响

Aims: Toevaluate currentevidence of glucagon-like peptide-1receptoragonists (GLP-1RAs) on blood pressure, heart rate, and hypertension in patients with type 2 diabetes.
 
Methods: Medline, Embase, the Cochrane library, and the website www.clinicaltrials.gov were searched on April 5th, 2014. Randomized-controlled trials with available data were included if they compared GLP-1RAs with placebo and traditional antidiabetic drugs in patients with type 2 diabetes with duration z 12 weeks. Weighted mean difference for blood pressure and heart rate, odds ratio (OR) for hypertension were calculated by random-effect model. Network meta-analysis was performed to supplement direct comparisons.
 
Results: sixtytrials with14treatments wereincluded. Compared withplacebo,insulin, and sulfonylureas, GLP-1RAs decreased systolic blood pressure with range from -1.84mmHg (95% CI: -3.48to -0.20)to -4.60 mmHg(95% CI:-7.18to-2.03). compared with placebo, a reduction in diastolic blood pressure was detected significantly only for exenatide-1oug twice-daily (-1.08mmHg,95%CI:-1.78to -0.33).Exenatide (2mgonceweekly),liraglutide 1.2 mgonce daily), and liraglutide (1.8mgonce daily) increased heartrate by3.35(95% CI: 1.23-5.50),2.06(95%CI: 0.43,3.74), and 2.35(95% CI: 0.94-3.76) beats/min versus placebo. This effect was evident compared with active control (range: 2.22-3.62). No significant association between incident hypertension and GLP-1RAs was detected, except for the association between exenatide-1o ug-twice-daily and sulfonylureas (OR,0.40,95% CI:0.16, 0.82).  
 
Conclusions: GLP-1RAs were associated with modest reduction on blood pressure, a slight increasein heartrate, yetnosignificantassociation withhypertension. Furtherinvestigation to explore mechanisms is warranted.