The role of incretins in salt-sensitive hypertension

PURPOSE OF REVIEW: Incretin mimetics, such as glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), as well as dipeptidyl peptidase-IV (DPP-IV) inhibitors, are used in the treatment of type 2 diabetes mellitus (T2DM). In addition to stimulating insulin secretion from pancreatic β cells, incretins have apparent extrapancreatic functions beyond glycemic control. This review summarizes the recent findings regarding the blood-pressure-lowering effects of incretins and DPP-IV inhibitors in patients who are obese, diabetic, or have metabolic syndrome. RECENT FINDINGS: Clinical studies have indicated that GLP-1 and its analogues lower blood pressure in patients with T2DM, particularly in patients with moderate-to-severe hypertension. DPP-IV inhibitors also appear to elicit a similar blood-pressure-lowering effect. In animal models of salt-sensitive hypertension, incretins appear to induce their antihypertensive effects by inhibiting the proximal tubular sodium reabsorption, and thereby increasing urinary excretion of sodium. These data suggest that the local actions of incretins may be via their key role in regulating natriuresis and lowering blood pressure. SUMMARY: Incretin mimetics and DPP-IV inhibitors are a novel class of antihypertensive drugs with natriuretic properties. They can be used in the treatment of salt-sensitive hypertension, which is characterized by edema.