Hypertension and diabetes frequently coexist and substantially increase cardiovascular (CV) risk, although the incremental benefit of intentionally combining antihypertensive (AHTN) and antidiabetic (ADA) therapies remains incompletely defined. A systematic review and meta-analysis published in Diabetes, Obesity and Metabolism evaluated the impact of combined AHTN and ADA therapy on cardiovascular outcomes, blood pressure (BP), and heart rate (HR).
The analysis searched MEDLINE, Embase, and Scopus through November 2025 and included randomized controlled trials (RCTs) comparing combined AHTN+ADA therapy versus AHTN or ADA monotherapy. Investigators assessed CV outcomes as well as BP and HR changes using random-effects models.
Nine RCTs involving 13,955 participants met the inclusion criteria. A prespecified exploratory analysis also evaluated CV outcome trials involving glucagon-like peptide-1 receptor agonists (GLP-1 RAs) compared with placebo.
Findings
- Combined AHTN+ADA therapy reduced composite CV events, CV death, and HF hospitalization compared with AHTN monotherapy.
- Combination therapy achieved modest but significant reductions in systolic BP (mean difference [MD] −2.57 mmHg) and diastolic BP (MD −1.03 mmHg).
- No excess risk of hypotension was observed with combination therapy.
- HR effects varied according to the specific treatment combination used.
- Exploratory analysis of 7 GLP-1 RA CV outcome trials involving approximately 56,000 participants showed reductions in composite CV events and CV death versus placebo, but no significant effect on HF hospitalization.
Combined AHTN and ADA therapy was associated with improved CV outcomes and modest BP reductions compared with monotherapy. The benefits appeared to be driven predominantly by SGLT2i-based combinations, while GLP-1 RAs showed complementary reductions in CV events and mortality without a clear HF benefit.
