Effects of empagliflozin on blood pressure and markers of arterial stiffness and vascular resistance in patients with type 2 diabetes.
OBJECTIVE
To determine the effects of empagliflozin on blood pressure (BP) and markers of arterial stiffness and vascular resistance in patients with type 2 diabetes mellitus (T2DM).


METHODS
We conducted a post hoc analysis of data from a phase III trial in patients with T2DM and hypertension receiving 12 weeks' empagliflozin and four phase III trials in patients with T2DM receiving 24 weeks' empagliflozin (cohort 1, n = 823; cohort 2, n = 2477). BP was measured using 24-h BP monitoring (cohort 1) or seated office measurements (cohort 2).


RESULTS
Empagliflozin reduced systolic BP (SBP) and diastolic BP in both cohorts (p < 0.001 vs placebo), without increasing heart rate. Empagliflozin reduced pulse pressure (PP; adjusted mean difference vs placebo cohort 1: -2.3 mmHg; cohort 2: -2.3 mmHg), mean arterial pressure (MAP; cohort 1, -2.3 mmHg; cohort 2, -2.1 mmHg) and double product (cohort 1, -385 mmHg × bpm; cohort 2, -369 mmHg × bpm) all p < 0.001 vs placebo. There was a trend towards a reduction in the ambulatory arterial stiffness index (AASI) with empagliflozin in cohort 1 (p = 0.059 vs placebo). AASI was not measured in cohort 2. Subgroup analyses showed that there were greater reductions in PP with increasing baseline SBP in cohort 1 (p = 0.092). In cohort 2, greater reductions in MAP were achieved in patients with higher baseline SBP (p = 0.027) and greater reductions in PP were observed in older patients (p = 0.011).


CONCLUSIONS
Empagliflozin reduced BP and had favourable effects on markers of arterial stiffness and vascular resistance.
Department of Medicine, University of Texas Health Science Center, San Antonio, TX, USA.
R
R
Chilton
Helsinki University Hospital and Minerva Institute for Medical Research, University of Helsinki, Helsinki, Finland.
I
I
Tikkanen
Department of Cardiology, Harvard Clinical Research Institute, Boston, MA, USA.
C P
CP
Cannon
Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany.
S
S
Crowe
Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany.
H J
HJ
Woerle
Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany.
U C
UC
Broedl
Boehringer Ingelheim Norway KS, Asker, Norway.
O E
OE
Johansen
D000368:Aged; D001161:Arteriosclerosis / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control*; D001559:Benzhydryl Compounds / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D015415:Biomarkers; D001794:Blood Pressure / Q000187:drug effects; D018660:Blood Pressure Monitoring, Ambulatory; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy*; D003925:Diabetic Angiopathies / Q000453:epidemiology / Q000517:prevention & control*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005960:Glucosides / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012306:Risk; D014655:Vascular Resistance / Q000187:drug effects; D059289:Vascular Stiffness / Q000187:drug effects
D001559:Benzhydryl Compounds; D015415:Biomarkers; D005960:Glucosides; D007004:Hypoglycemic Agents; C570240:empagliflozin
SGLT2 inhibitor; cardiovascular disease; phase III study; type 2 diabetes