SGLT2 Inhibitor Lowers Blood Pressure Across Medication Classes

The sodium glucose co-transporter 2 (SGLT2) inhibitor dapagliflozin reduced HbA1c, blood pressure, and serum uric acid in patients with inadequately controlled type 2 diabetes and hypertension regardless of the class of  antihypertensive medication that patients were taking, according to the results of a study presented at the American Heart Association Scientific Sessions 2014.

“This study adds to our understanding of the efficacy and safety of dapagliflozin in patients with type 2 diabetes and hypertension,” said Michael A. Weber, MD, of SUNY Downstate College of Medicine, Brooklyn, N.Y. 

Dapagliflozin and other SGLT2 inhibitors reduce hyperglycemia by increasing urinary glucose excretion.

Weber and colleagues conducted a 12-week, double-blind trial of 449 patients with inadequately controlled type 2 diabetes and hypertension despite treatment with  antihyperglycemic medication and/or insulin, plus an ACE inhibitor or ARB, plus a second antihypertensive medication. Patients were assigned to receive dapagliflozin 10 mg or placebo plus either an ACE inhibitor or an angiotensin receptor blocker (ARB) plus an additional antihypertension medication.

Results of the original analysis showed that dapagliflozin significantly reduced seated blood pressure and HbA1c after 12 weeks of treatment.

Because the blood pressure lowering effect demonstrated with dapagliflozin is attributed to osmotic diuresis resulting from glucosuria and associated weight loss, in this analysis, Weber and colleagues were interested in comparing the HbA1c and blood pressure reductions in patients treated with a diuretic to those treated with a beta blocker (BB) or calcium channel blocker (CCB).

Results showed that dapagliflozin 10 mg significantly reduced HbA1c, blood pressure, and serum uric acid regardless of which additional antihypertensive treatment was used.

“Reductions in HbA1c and blood pressure were numerically similar across subgroups of dapagliflozin-treated patients, but the placebo subgroups showed variable responses,” Weber said. “The effect of dapagliflozin vs. placebo was not as pronounced among patients in the diuretic sub-group as it was in the other antihypertensive sub-groups, perhaps due to the diuretic effect that was also contributed by the dapagliflozin.”

Overall the treatment was well-tolerated with no unexpected safety events.

References:

Weber MA, Mansfield TA, Iqbal N, et al. #13640. Dapagliflozin lowers HbA1c, systolic blood pressure and serum uric acid in patients with type 2 diabetes and hypertension, regardless of class of concomitant antihypertensive therapy. Presented at: American Heart Association Scientific Sessions 2014; Nov. 16-19, 2014; Chicago.