Empagliflozin beneficial for uncontrolled nocturnal hypertension
medwireNews: The addition of empagliflozin reduces nighttime blood pressure in older diabetes patients who have nocturnal hypertension despite medication including angiotensin receptor blockers (ARBs), show findings from a randomized trial.
During 12 weeks of treatment, average nighttime systolic blood pressure (SBP) fell by a significant 6.3 mmHg among 68 patients taking empagliflozin 10 mg, compared with a nonsignificant reduction of 2.0 mmHg among 63 patients taking placebo.
The between-group difference in blood pressure change, of 4.3 mmHg, was not statistically significant.
However, Kazuomi Kario (Jichi Medical University School of Medicine, Shimotsuke, Japan) and co-researchers note that this difference, as well as the change from baseline in the empagliflozin group, “were of a magnitude that is likely to have important clinical implications given that a 5-mmHg reduction in mean nighttime SBP has been independently associated with a 20% reduction in cardiovascular risk.”
The patients were all Japanese and aged approximately 70 years on average, with diabetes that was of around 10 years’ duration but well controlled, with average glycated hemoglobin levels being 6.6% (49 mmol/mol). Besides taking ARBs, about two-thirds of the patients were also taking calcium channel blockers and a quarter were taking diuretics, with smaller proportions taking alpha-blockers, beta-blockers, and other antihypertensive medications.
Their daytime SBP was relatively well controlled, at an average of 143.0 and 137.7 mmHg in the empagliflozin and placebo groups, respectively, but all had nocturnal hypertension, defined as SBP of at least 115 mmHg at 02:00, 03:00, and 04:00 during sleep 5 days before randomization, measured at home.
Average daytime SBP fell by a significant 11.7 mmHg in the empagliflozin group versus a nonsignificant 2.1 mmHg in the placebo group, with the difference between the two being statistically significant, and the same was true for 24-hour SBP, at 10.0 versus 2.4 mmHg.
Furthermore, morning SBP fell by an average of 12.7 mmHg in the empagliflozin group, which the researchers say is “of a clinically relevant magnitude” as well as being statistically significant versus the 5.2 mmHg in the placebo group.
“This morning home BP reduction is particularly relevant in patients of Asian ethnicity who have been shown to have an exaggerated morning BP surge and morning hypertension compared with Western populations, and are at increased stroke risk,” they write in Circulation.
Glycated hemoglobin fell from an average of 6.6% to 6.4% (49 to 46 mmol/mol) in the empagliflozin group versus a slight rise to 6.7% (50 mmol/mol) in the placebo group.
The team concludes that using sodium-glucose cotransporter 2 inhibitors “in specific groups such as those with nocturnal hypertension, diabetes, and high salt sensitivity, could help to reduce the risk of heart failure and cardiovascular mortality in these patients.”
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