Hypertension and nephrology

[GLP-1 receptor agonists in the treatment of type 2 diabetes]

WINKLER Gábor

OCTOBER 23, 2019

Hypertension and nephrology - 2019;23(05)

DOI: https://doi.org/10.33668/hn.23.023

[The glucagon-like peptide (GLP)-1 receptor agonists and somewhat later, the sodium-glucose cotransporter (SGLT) -2 inhibitors have brought new perspectives in the antihyperglycemic treatment of type 2 diabetes. The article overviews clinicopharmacologic characteristics of the GLP-1 receptor agonist group, their glycemic and non-glycemic effects, results of the cardiovascular endpoint studies as well as their place in the recent therapeutic guidelines. It is proven, that both glycemic and weight reducing effect is greater of the long-acting (non-prandial) coumpounds as compared to that of the short acting (prandial) derivates, further, that in studies with cardiovascular endpoints they reduced the relative risk of the composite endpoint of non-fatal myocardial infarct, non-fatal stroke and cardiovascular death. Due to the favolurable glycemic and non-glycemic properties their use is advised already in the early course of type 2 diabetes, as combination of the metformin therapy.]

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[Hypertension is the leading modifiable risk factor for stroke. Its prevalence amongst stroke patient is about 60-70% and the benefit of blood pressure (BP) lowering therapy on stroke risk reduction is well established. However the optimal BP targets for preventing stroke and reducing stroke consequences have been controversial. The new European (ESC/ESH) and Hungarian (HSH) hypertension guideline published in 2018 highlighted the primary and secondary prevention of stroke and the BP management in the acute stroke care as well. According results from ACCORD, SPRINT, HOPE-3, and other metaanalysis the systolic blood pressure (SBP) lowering < 120 mmHg has not favourable effect, thus in hypertensive patients < 65 years the SBP should be lowered to a BP range of 120-129 mmHg. In older patients ≥ 65 years the SBP should be targeted to a BP range of 130-139 mmHg (IA). In patients with acute intracerebral haemorrhage careful acute BP lowering with iv. therapy, to <180 mmHg should be considered only in case of SBP ≥ 220 mmHg (IIaB). In patients with acute ischaemic stroke who are eligible for iv. thrombolysis, BP should be carefully lowered and maintained to < 180/105 mmHg for at least the first 24 h after thrombolysis (IIaB). If the patient is not eli gible for lysis and BP ≤ 220/110 mmHg, routine BP lowering drug therapy is not recommended inside 48-72 h (IA). In patients with markedly elevated BP > 220/110 mmHg who do not receive fibrinolysis, drug therapy may be considered, based on clinical judgement, to reduce BP by 15% during the first 24 h after the stroke onset (IIbC). After 72 h of acute stroke in case of hypertensive patients < 65 years the SBP should be lowered to a BP range of 120-129 mmHg (IIaB). In older patients ≥ 65 years the SBP should be targeted to a BP range of 130-139 mmHg (IA). If BP < 140/90 mmHg after stroke, the BP lowering should be considered (IIbA). It is recommended to initiate an antihypertensive treatment with combination, preferably single pill combination of renin-angiotensin system blockers plus a calcium channel blocker and/or a thiazide like diuretics (IA). Lowering SBP < 120 mmHg is not recommended due to advers events regardless of age and type of stroke either in primary or secondary stroke prevention.]

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