Clinical factors influencing the systolic blood pressure benefits of once-weekly semaglutide in patients with type 2 diabetes.

INTRODUCTION: Type 2 diabetes mellitus (T2DM), a major cardiovascular risk, is often associated with obesity and hypertension. Once-weekly subcutaneous semaglutide (OWS-Sema) can improve these conditions, but factors influencing blood pressure (BP) effects are not well studied. This study aimed to assess the impact of OWS-Sema on systolic BP (SBP) and identify clinical factors associated with its reduction in patients with T2DM. METHODS: Sub-analysis of the REALSEM-SP study involving OWS-Sema-naïve patients with T2DM. Changes in SBP and diastolic BP (DBP) and influencing factors were analyzed over 12 months. RESULTS: One hundred seventy-eight patients were included (mean age 61±10 years, 43.8% female, 79.2% with hypertension). Median baseline SBP and DBP were 132 [122-145] and 80 [72-88]mmHg, respectively. SBP decreased by -4mmHg at 6 months and -2mmHg at 12 months (p=0.014), while DBP showed no significant change (p=0.395). Factors independently associated with SBP reduction at 6 months included uncontrolled BP and a glomerular filtration rate ≥60mL/min/1.73m, while at 12 months, only uncontrolled BP remained significant. A SBP ≥10mmHg reduction was associated with uncontrolled BP, dyslipidemia and renal function at 6-month, and only with uncontrolled BP at 12-month. CONCLUSION: OWS-Sema was associated with significant reductions in office SBP in T2DM patients, especially those with uncontrolled baseline BP, independent of BMI changes or dose. Patients with baseline uncontrolled BP appear to benefit the most.