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LETTER TO EDITOR
Year : 2021  |  Volume : 20  |  Issue : 2  |  Page : 154-155  

Effect of 3-month therapy with empagliflozin on ambulatory blood pressure and arterial stiffness in patients with type 2 diabetes mellitus


1 First Department of Internal Medicine, Diabetes Center, Tzaneio General Hospital of Piraeus, Piraeus, Greece
2 Diabetes and Cardiometabolic Center, Metropolitan Hospital, Piraeus, Greece

Date of Submission29-Mar-2020
Date of Decision22-May-2020
Date of Acceptance15-Jun-2020
Date of Web Publication30-Jun-2021

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aam.aam_19_20

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How to cite this article:
Papazafiropoulou AK, Mpoumi L, Papantoniou S, Rallatou M, Antonopoulos S, Melidonis A. Effect of 3-month therapy with empagliflozin on ambulatory blood pressure and arterial stiffness in patients with type 2 diabetes mellitus. Ann Afr Med 2021;20:154-5

How to cite this URL:
Papazafiropoulou AK, Mpoumi L, Papantoniou S, Rallatou M, Antonopoulos S, Melidonis A. Effect of 3-month therapy with empagliflozin on ambulatory blood pressure and arterial stiffness in patients with type 2 diabetes mellitus. Ann Afr Med [serial online] 2021 [cited 2021 Sep 27];20:154-5. Available from: https://www.annalsafrmed.org/text.asp?2021/20/2/154/320034



Sir,

It is well established that the co-existence of type 2 diabetes (T2D) and hypertension increases the risk of cardiovascular mortality.[1] Empagliflozin, in addition to its anti-hyperglycemic effect, has a favorable profile in weight reduction, blood pressure (BP), and arterial stiffness.[1] Therefore, the purpose of this study is to evaluate the effect of empagliflozin on ambulatory BP and pulse wave velocity (PWV), a biomarker of arterial stiffness, in patients with poorly controlled T2D.

A total of 32 patients (16 men) with T2D, with a mean age (± standard deviation) of 64.8 ± 7.1 years, HbA1c of 8.2% ± 1.3%, body mass index of 32.1 ± 9.2 kg/m2, and duration of T2D of 10.1 ± 4.3 years, attending the outpatient diabetic Center of the General Hospital of Piraeus between September and December 2019, were included in the study. All patients underwent a complete clinical examination, laboratory testing, measurement of PWV, and ambulatory BP recording both on entry into the study and 3 months after the initiation of empagliflozin treatment (background antidiabetic therapy remained stable during the study period). Ambulatory BP and PWV were measured with the oscillometric Mobil-O-Graph® NGW 24-h ambulatory BP and PWA monitor (IEM; Stolberg, Germany). The study was approved by the Hospital's Ethics Committee, and was conducted in accordance with the Declaration of Helsinki. Written informed consent was obtained from all participants.

At baseline, the study participants had a mean daytime systolic BP (SBP) and diastolic BP (DBP) of 129.6 ± 14.8 and 78.1 ± 9.9 mmHg, respectively. After 3 months of empagliflozin therapy, daytime SBP and DBP were 128.2 ± 10.4 and 78.3 ± 7.8 mmHg, respectively. The mean change of daytime SBP and DBP from baseline was –1.4 mmHg (standard error [SE] = 2.6, P = 0.61) and 0.2 mmHg (SE = 1.9, P = 0.91), respectively. Nighttime SBP and DBP at baseline were 126.3 ± 12.5 and 74.1 ± 8.7 mmHg, respectively, while after 3-month therapy, they were 117.4 ± 9.3 and 69.6 ± 7.1 mmHg, respectively. The mean change of nighttime SBP and DBP from baseline was –8.9 mmHg (SE = 3.3, P = 0.03) and −4.5 mmHg (SE = 1.5, P = 0.02), respectively. Pulse pressure fell from 52.4 ± 9.3 (baseline) to 50.4 ± 8.0 mmHg (month 3) and heart rate from 75.5 ± 8.5 ± 10.1 (baseline) to 73.7 ± 7.4 bpm (month 3). The mean change from pulse pressure and heart rate was –2.0 mmHg (SE = 1.7, P = 0.28) and –1.8 bpm (SE = 2.2, P = 0.44), respectively. It is noteworthy, that despite the short period of patients' follow-up, empagliflozin reduced PWV from 9.56 ± 1.34 (baseline) to 8.84 ± 0.90 m/s (month 3) (P = 0.02) [Table 1].
Table 1: Changes in systolic and diastolic blood pressure as well as pulse wave velocity after 3 months of empagliflozin therapy

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The results of the present study showed a favorable effect of 3-month therapy with empagliflozin on nighttime SBP and DBP. Furthermore, empagliflozin therapy resulted in a statistically significant reduction of PWV, a finding that might explain in part its cardioprotective effects that have been confirmed with major clinical trials.[1]

The favorable effect of empagliflozin on BP is well established.[1],[2],[3] A recent experimental study showed that empagliflozin improved SBP, endothelial dysfunction, and heart remodeling.[2] Another study on T2D patients showed that the combination therapy of empagliflozin and liraglutide significantly improved central BP and vascular function compared to the classic combination of insulin and metformin.[3]

The most important finding of the present study is the beneficial effect of empagliflozin on PWV, a marker of arterial stiffness. It has been shown that empagliflozin therapy induced improvement of vascular parameters of arterial stiffness in T2D patients.[4] The beneficial effect was independent of the observed change in glucose metabolism and blood volume status.[4] In addition, a post hoc analysis of data from a Phase III trial in patients with T2D showed that empagliflozin reduced BP and had favorable effects on the markers of arterial stiffness and vascular resistance, confirming the results of the present study.[5]

In conclusion, 3-month therapy with empagliflozin had a favorable effect on ambulatory BP, in terms of nighttime SBP and DBP. Furthermore, empagliflozin therapy showed a statistically significant reduction of PWV, a finding that might explain in part empagliflozin's cardioprotective effects and need further investigation with large clinical trials.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Tentolouris A, Vlachakis P, Tzeravini E, Eleftheriadou I, Tentolouris N. SGLT2 inhibitors: A review of their antidiabetic and cardioprotective effects. Int J Environ Res Public Health 2019;16:2965.  Back to cited text no. 1
    
2.
Park SH, Farooq MA, Gaertner S, Bruckert C, Qureshi AW, Lee HH, et al. Empagliflozin improved systolic blood pressure, endothelial dysfunction and heart remodeling in the metabolic syndrome ZSF1 rat. Cardiovasc Diabetol 2020;19:19.  Back to cited text no. 2
    
3.
Jung S, Bosch A, Kannenkeril D, Karg MV, Striepe K, Bramlage P, et al. Combination of empagliflozin and linagliptin improves blood pressure and vascular function in type 2 diabetes. Eur Heart J Cardiovasc Pharmacother 2019. pii: pvz078.  Back to cited text no. 3
    
4.
Bosch A, Ott C, Jung S, Striepe K, Karg MV, Kannenkeril D, et al. How does empagliflozin improve arterial stiffness in patients with type 2 diabetes mellitus? Sub analysis of a clinical trial. Cardiovasc Diabetol 2019;18:44.  Back to cited text no. 4
    
5.
Chilton R, Tikkanen I, Cannon CP, Crowe S, Woerle HJ, Broedl UC, et al. Effects of empagliflozin on blood pressure and markers of arterial stiffness and vascular resistance in patients with type 2 diabetes. Diabetes Obes Metab 2015;17:1180-93.  Back to cited text no. 5
    



 
 
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