Which canagliflozin dose is best for T2DM patients with hypertension?

A recent meta-analysis offers new proof of different canagliflozin doses for hypertension management in patients with type 2 diabetes mellitus (T2DM) complicated by hypertension. However, low-density lipoprotein cholesterol (LDL-C) and the risk of urinary tract infection must be observed.

Randomized controlled trials in patients with T2DM were included in this meta-analysis. The researchers explored the databases of Medline, the Cochrane Library of Trials, and Clinicaltrials.gov for relevant studies from January 2008 to May 2021.

Canagliflozin 100 mg lowered systolic BP (SBP) by 3.43 mm Hg and diastolic BP (DBP) by 1.05 mm Hg relative to placebo. It also increased LDL-C by 0.10 mmol/l and high-density lipoprotein cholesterol (HDL-C) by 0.05 mmol/l.

On the other hand, canagliflozin 300 reduced SBP by 4.75 mm Hg and DBP by 1.69 mm Hg compared with placebo. It also elevated LDL-C by 0.16 mmol/l and HDL-C by 0.06 mmol/l.

Canagliflozin 300 mg, compared with 100 mg, further reduced SBP by 1.21 mm Hg and DBP by 0.64 mm Hg and further increased LDL-C by 0.06 mmol/l and HDL-C by 0.02 mmol/l. In addition, canagliflozin 300 mg increased the risk of UTI relative to placebo and canagliflozin 100 mg.

“Canagliflozin is a sodium glucose-cotransporter-2 receptor inhibitor approved for the treatment of T2DM. However, it is less prescribed due to increased LDL-C, high incidence of UTI, [and] high cost,” the researchers said.