SGLT2 inhibitors change blood pressure, affect renal outcomes in T2DM

In type 2 diabetes mellitus (T2DM) patients, the use of sodium-glucose cotransporter 2 (SGLT2) inhibitors reduces blood pressure (BP) which, in turn, influences renal outcomes, a new Japan study has found.

Data from 624 T2DM patients were retrospectively reviewed. Participants had chronic kidney disease and had been on SGLT2 inhibitors for >1 year. The primary composite endpoint was albuminuria progression or a ≥15-percent annual reduction in the estimated glomerular filtration rate.

Seventy-one patients reached the composite outcome, yielding an incidence rate of 11.4 percent. Receiver operating characteristic curve analysis identified an optimal cutoff of –4.0 mm Hg for the change in mean arterial pressure (MAP) as a marker for the renal composite outcome.

Univariate regression found that change in MAP above the cutoff value increased the risk of the composite outcome with borderline significance (odds ratio [OR], 1.64, 95 percent confidence interval [CI], 0.98–2.73; p=0.056).

Patients were then categorized into two according to the change in MAP: > –4.0 mm Hg and ≤ –4.0 mm Hg. After propensity score matching, each group contained 173 patients.

After treatment SGLT2 inhibitors, the renal composite outcome occurred significantly less frequently in the latter group (5.8 percent vs 15.6 percent), corresponding to a threefold increase in risk in the former group (odds ratio, 3.01, 95 percent confidence interval, 1.41–6.44; p=0.003).

“Given these results, general practitioners should recognize the importance of BP management, even during SGLT2 inhibitor treatment, in these patients,” the researchers said.