Zhao_2026_Diabetes.Obes.Metab__

BACKGROUND: Dipeptidyl peptidase-4 inhibitors (DPP-4i) are incretin-based agents for type 2 diabetes mellitus (T2DM) and might reduce blood pressure (BP). This study aims to assess their effects on seated- and ambulatory BP (ABP). METHODS: PubMed, Embase and the Cochrane Library were searched for randomised controlled trials reporting systolic BP (SBP), diastolic BP (DBP) or ABP. Placebo-controlled and active-controlled comparisons were analysed separately. Subgroup and meta-regression analysis were prespecified as exploratory. Risk of bias and certainty of evidence were assessed using the Cochrane tool and GRADE, respectively. The protocol was registered in PROSPERO (CRD42019138927). RESULTS: Sixty-seven publications comprising 79 studies were included and only 11 studies were rated as high quality. Compared with placebo, DPP-4i produced a small reduction in seated SBP (-1.69 mmHg; 95% CI, -2.78 to -0.61, I(2) = 18%; 26 studies; n = 2587 participants). In the exploratory renin-angiotensin-aldosterone system inhibitors (RAASi) co-administration subgroup, seated SBP was lower by -1.60 mmHg (95% CI, -3.04 to -0.16; I(2) = 57%; 39 studies; n = 4064 participants), with moderate heterogeneity. In participants with baseline HbA1c >= 7.5%, the DBP estimate was borderline (-0.85 mmHg; 95% CI, -1.71 to 0.00; 22 studies; n = 1655 participants) and was not considered robust evidence of benefit. High-quality studies showed no detectable changes in seated SBP or DBP. ABP analyses showed no detectable differences based on only three publications (four studies). Estimates were exploratory and underpowered and certainty was low to very low. CONCLUSIONS: DPP-4i might produce a small reduction in seated SBP compared with placebo, but the magnitude was modest and the clinical relevance for individual patients was uncertain. Evidence for DBP and ABP effects was inconclusive. These findings did not support the use of DPP-4i as BP-lowering therapy, and adequately powered trials with standardised BP protocols are needed.