The impact of intragastric balloon and therapy by glucagon-like peptide‑1 receptor agonist on arterial hypertension and other components of metabolic syndrome

Objective. Underlying the development of insulin resistance (IR), abdominal obesity (AO) to a large extent determines the occurrence of both type 2 diabetes mellitus (T2DM) and arterial hypertension (HTN). Consequently, obesity treatment has a pathogenetic significance. However, in T2DM there are certain associated difficulties. Feasible methods in this group are the intra-gastric balloon (IGB) implantation and glucagon-like peptide‑1 (aGLP‑1) receptor agonists.

The aim of the study was to compare the effects of IGB therapy and aGLP‑1 therapy on the various components of metabolic syndrome (including HTN) in T2DM patients.

Design and methods. The study involved 19 patients, aged from 18 to 65 years old, with obesity (BMI > 35 kg/m 2), T2DM, AO, and HTN. IGB (“MedSil”, Russia) was inserted in 10 patients, and subcutaneous injection of GLP‑1 (exenatid) was administered to 9 patients. At each visit (0, 2nd, 6th, 12th, and 24th week of research) anthropometric parameters, systolic (SBP) and diastolic blood pressure (DBP), as well as the required number and dosage of hypoglycemic and anti-hypertonic medication were assessed. At baseline and after 24 weeks of treatment, indicators of T2DM compensation were assessed, and HOMA index was calculated.

Results. After 24 weeks of treatment, there was a decrease in BMI by 5,1 [2,4; 8,1] kg/m 2 (p < 0,0001), HbA1c by 1,1 [0,5; 2,0] % (p = 0,04), SBP by 17 [7,8; 26,3] mm Hg (p = 0,003), DBP by 13,0 [6,5; 19,5] mm Hg (p = 0,000) in the IGB group, whereas in the aGLP‑1 group BMI decreased by 3,4 [2,7; 4,1] kg/m 2 (p = 0,000), HbA1‑by 1,0 [0,8; 1,9] % (p = 0,008), SBP — by 20 [4,0; 33,0] mm Hg (p = 0,009), DBP — by 12,0 [1,5; 16,5] mm Hg (p = 0,003). However, the differences between the groups were not significant (p > 0,05).

Conclusions. Both the insertion of IGB and aGLP‑1 therapy resulted in a comparable decrease in BMI, HB1C, and BP level in obese patients with T2DM.

1. Shalnova SA, Balanova YA, Konstantinov VV, Timofeeva TN, Ivanov VM, Kapustina AV et al. Arterial hypertension: prevalence, awareness, antihypertensive drugs and treatment efficacy in the population of Russian Federation. Rossiyskiy kardiologicheskii zhurnal = Rossijskij Kardiologicheskij Zhurnal = Russian Journal of Cardiology. 2006;4:45–50.

2. Krasilnikova EI, Baranova EI, Blagosclonnaya YV. Pathogenetic features of arterial hypertension in patients with metabolic syndrome. Systemnye Gipertenzii = System Hypertension. 2012;1:40–45.

3. Chazova IE, Mychka VB. Metabolic syndrome, type 2 diabetes mellitus and hypertension. Serdtse = Heart. 2003;2(3):102–44.

4. Blagosclonnaya YV, Krasilnikova EI, Shlyakhto EV. Metabolic cardiovascular syndrome. Uchenye Zapiski = Scientific Notes. 2002;9(3):111–115.

5. Gress TW, Nieto FJ, Shahar E, Wofford MR, BrancatiFL. Hypertension and antihypertensive therapy as risk factors for type 2 diabetes mellitus. N Engl J Med. 2000;342 (13):905–912. doi: 10.1056/NEJM200003303421301.

6. Solomaa VV, Strandberg TE, Vanhanem H, Naukkarinen V, Sarna S, Miettinen TA. Glucose tolerance and blood pressure: long term follow up in middle aged men. Br Med J. 1991;302(6775):493–496.

7. D’Agostino RB, Vasan RS, Pencina MJ. General cardiovascular risk profile for use in primary care. The Framingham Heart Study. Circulation. 2008;117(6):743–753. doi: 10.1161/CIRCULATIONAHA.107.699579.

8. Franz MJ, VanWormer JJ, Crain AL, Boucher JL, Histon T, Caplan W et al. Weight-loss outcomes: a systematic review and meta-analysis of weight-loss clinical trials with a minimum 1-year follow-up. J Am Diet Assoc. 2007;107(10):1755–1767.

9. Wang B, Zhong J, Lin H, Zhao Z, Yan Z, He H et al. Blood pressure-lowering effects of GLP-1 receptor agonists exenatide and liraglutide: a meta-analysis of clinical trials. Diabet Obes Metab. 2013;15(8):737–749. doi: 10.1111/dom.12085.

10. Genco A, Bruni T, Doldi SB, Forestieri P, Marino M, Busetto L et al. BioEntericsintragastric balloon: the Italian experience with 2.515 patients. Obes Surg. 2005;15(8):1161–1164.

11. Forlano R, Ippolito AM, Iacobellis A, Merla A, Valvano MR, Niro G et al. Effect of the BioEntericsintragastric balloon on weight, insulin resistance, and liver steatosis in obese patients. Gastrointest Endosc. 2010;71:927–933. doi: 10.1016/j.gie.2009.06.036.

12. Yasawy MI, Al-Quorain AA, Hussameddin AM, Yasawy ZM, Al-Sulaiman RM. Obesity and gastric balloon. J Family Community Med. 2014;21(3):196–199. doi: 10.4103/2230–8229.142977.

13. Mathus-Vliegen EM, Eichenberger RI. Fasting and meal-suppressed ghrelin levels before and after intragastric balloons and balloon-induced weight loss. Obes Surg. 2014;24(6):909–915. doi: 10.1007/s11695-013-1053-5.

14. Konopko-Zubrzycka M, Baniukiewicz A, Wróblewski E, Kowalska I, Zarzycki W, Górska M et al. The effect of intragastric balloon on plasma ghrelin, leptin, and adiponectin levels in patients with morbid obesity. J Clin Endocrinol Metab. 2009;94(5):1644–1649. doi: 10.1210/jc.2008–1083.

15. Potts JE, Gray LJ, Brady EM, Khunti K, Davies MJ, Bodicoat DH. The effect of glucagon-like peptide 1 receptor agonists on weight loss in type 2 diabetes: a systematic review and mixed treatment comparison metaanalysis. PloS One. 2015;10(6): e0126769. doi: 10.1371/journal.pone.0126769.

16. Sun F, Chai S, Li L, Yu K, Yang Z, Wu S et al. Effects of glucagon-like peptide-1 receptor agonists on weight loss in patients with type 2 diabetes: a systematic review and network meta-analysis. J Diabetes Res. 2015;2015:157201. doi: 10.1155/2015/157201.

17. Zerrweck C, Maunoury V, Caiazzo R, Branche J, Dezfoulian G, Bulois P et al. Preoperative weight loss with intragastric balloon decreases the risk of significant adverse outcomes of laparoscopic gastric bypass in supersuper obese patients. Obes Surg. 2012;22(5):777–782. doi: 10.1007/s11695–011–0571–2.

18. Crea N, Pata G, Della Casa D, Minelli L, Maifredi G, Betta ED et al. Improvement of metabolic syndrome following intragastric balloon: 1 year follow-up analysis. Obes Surg. 2009;19(8):1084–1088. doi: 10.1007/s11695–009–9879–6.