Abstract 18574: Empagliflozin Reduces Systolic Blood Pressure in Dipper and Non-Dipper Patients with Type 2 Diabetes and Hypertension

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Robert Chilton ◽  
Ilkka Tikkanen ◽  
Susanne Crowe ◽  
Odd Erik Johansen ◽  
Uli C Broedl ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Heart Rate ◽  
Systolic Blood Pressure ◽  
Randomized Trial ◽  
Sleep Time ◽  
Phase Iii ◽  
Once Daily ◽  
Ambulatory Bp Monitoring

In a Phase III randomized trial (EMPA-REG BP™), patients with type 2 diabetes (T2DM) and hypertension (defined as mean seated office systolic blood pressure [SBP] 130-159 mmHg and diastolic BP [DBP] 80-99 mmHg at screening) received empagliflozin (EMPA) 10 mg (n=276), EMPA 25 mg (n=276) or placebo (PBO; n=271) once daily in the morning for 12 weeks (mean [SD] age 60.2 [9.0] yrs, HbA1c 7.90 [0.74] %, 24-h SBP 131.4 [12.3] mmHg, 24-h DBP 75.0 [7.8] mmHg). We assessed changes from baseline in SBP (mean 24-h, awake-time, sleep-time) via ambulatory BP monitoring at week 12 in patients categorized as dippers (sleep-time mean SBP ≤90% of awake-time mean; n=417) or non-dippers (sleep-time mean SBP >90% of awake-time mean; n=350). Baseline mean (SD) 24-h SBP (mmHg) was 129.9 (11.6) in dippers and 133.1 (12.4) in non-dippers. Adjusted mean (SE) changes from baseline in mean 24-h SBP (mmHg) in dippers were -0.2 (0.7) with PBO vs -3.8 (0.6) and -3.9 (0.7) with EMPA 10 and 25 mg, respectively (both p<0.001), and in non dippers were 1.0 (0.7) with PBO vs -1.6 (0.7) with EMPA 10 mg (p=0.013) and -3.8 (0.7) with EMPA 25 mg (p<0.001). Hourly mean SBP patterns over 24 h for dippers and non-dippers were maintained with EMPA 25 mg (Figure) and 10 mg. Adjusted mean (SE) changes from baseline in awake-time SBP (mmHg) in dippers were -0.5 (0.7) with PBO vs -4.6 (0.7) with EMPA 10 and 25 mg (both p<0.001), and in non dippers were 1.3 (0.8) with PBO vs -2.2 (0.8) with EMPA 10 mg (p=0.002) and -4.2 (0.7) with EMPA 25 mg (p<0.001). Adjusted mean (SE) changes from baseline in sleep-time SBP (mmHg) in dippers were 0.4 (0.8) with PBO vs -2.6 (0.8) with EMPA 10 mg (p=0.007) and -2.2 (0.8) with EMPA 25 mg (p=0.022), and in non-dippers were 0.1 (0.9) with PBO vs -0.5 (0.9) with EMPA 10 mg (p=0.603) and -3.2 (0.8) with EMPA 25 mg (p=0.006). There were no apparent differences in heart rate with EMPA vs PBO in dippers or non-dippers. In patients with T2DM and hypertension, EMPA 10 mg and 25 mg significantly reduced SBP vs PBO in dippers and non-dippers.

Abstract P368: Effects of Empagliflozin on Day-to-day Variability of Home Blood Pressure and Heart Rate in Patients with Type 2 Diabetes

Hypertension ◽  
2017 ◽  
Vol 70 (suppl_1) ◽  
Author(s):  
Tatsuo Misawa ◽  
Yumi Kawagoe ◽  
Fujiko Oda ◽  
Misao Ogata
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Heart Rate ◽  
Standard Care ◽  
Home Blood Pressure ◽  
High Cardiovascular Risk ◽  
Once Daily ◽  
Oscillometric Device ◽  
At Home

Background: The effects of empagliflozin in addition to standard care, on day-to-day variability of self-measured home blood pressure (BP) and heart rate (HR) at home in patients with type 2 diabetes (T2DM) at high cardiovascular risk are not known. Method: We followed twenty-three consecutive T2DM patients (mean age: 69 years old, 12 men) to add 10 mg of empagliflozin once daily for three months. Home BP and HR were measured once every morning at home, using an oscillometric device. The variability of BP and HR were defined as the standard deviations (SD) of measurements which were performed on seven consecutive days. Results: For home blood pressure, empagliflozin significantly reduced systolic blood pressure (SBP) from 130±11 mmHg at baseline to 126±11 mmHg at the first week(1W) of the administration (P<0.05). SBP achieved the target home BP goal (125±11 mmHg) at the second week(2W) and was maintained during the study (P<0.01). As regards day-to-day variability of SBP, SD decreased from 7.3±3.5 mmHg at baseline to 6.7±2.5 mmHg at 1W (4W: 6.4±2.8 mmHg, 8W: 5.2±2.3 mmHg, P<0.05). In diastolic blood pressure (DBP), there was a significant reduction of SD compared with that at baseline (4.9±1.6 mmHg at baseline, 4W: 4.3±1.6 mmHg, 8W: 3.9±1.8 mmHg, 12W: 4.4±1.6 mmHg, P<0.05); however, there was no change of DPB (71±10 mmHg at baseline, 12W: 71±8 mmHg). Similarly, there was a decreasing trend in SD of HR (3.9±1.0 beats per minute (bpm) at baseline, 4W: 3.3±1.3 bpm, 12W: 3.1±1.3 bpm, P<0.1), although there was no significant change in HR (62±13 bpm at baseline, 12W: 61 ± 12 bpm). Conclusion: Empagliflozin tended to reduce the day-to-day variability of self-measured morning home BP and HR.

scholarly journals Physical activity, sedentary time and their associations with clustered metabolic risk among people with type 2 diabetes in Jiangsu province: a cross-sectional study

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e027906
Author(s):  
Yijia Chen ◽  
Jie Yang ◽  
Jian Su ◽  
Yu Qin ◽  
Chong Shen ◽  
...  
Keyword(s):  
Physical Activity ◽  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Systolic Blood Pressure ◽  
Leisure Time ◽  
Sedentary Time ◽  
Leisure Time Physical Activity ◽  
Jiangsu Province ◽  
Metabolic Risk

ObjectiveInvestigating the association between total physical activity, physical activity in different domains and sedentary time with clustered metabolic risk in patients with type 2 diabetes from Jiangsu province, China.DesignInterview-based cross-sectional study conducted between December 2013 and January 2014.Setting44 selected townships across two cities, Changshu and Huai’an, in Jiangsu province.Participants20 340 participants selected using stratified cluster-randomised sampling and an interviewer-managed questionnaire.MethodsWe constructed clustered metabolic risk by summing sex-specific standardised values of waist circumference, fasting triacylglycerol, fasting plasma glucose, systolic blood pressure and the inverse of blood high-density lipoprotein cholesterol (HDL-cholesterol). Self-reported total physical activity included occupation, commuting and leisure-time physical activity. The un-standardised regression coefficient [B] and its 95% CI were calculated using multivariate linear regression analyses.ResultsThis study included 17 750 type 2 diabetes patients (aged 21–94 years, 60.3% female). The total (B=−0.080; 95% CI: −0.114 to −0.046), occupational (B=−0.066; 95% CI: −0.101 to− 0.031) and leisure-time physical activity (B=−0.041; 95% CI: −0.075 to −0.007), and sedentary time (B=0.117; 95% CI: 0.083 to 0.151) were associated with clustered metabolic risk. Total physical activity, occupational physical activity and sedentary time were associated with waist circumference, triacylglycerol and HDL-cholesterol, but not with systolic blood pressure. Commuting physical activity and sedentary time were significantly associated with triacylglycerol (B=−0.012; 95% CI: −0.019 to −0.005) and fasting plasma glucose (B=0.008; 95% CI: 0.003 to 0.01), respectively. Leisure-time physical activity was only significantly associated with systolic blood pressure (B=−0.239; 95% CI: −0.542 to− 0.045).ConclusionsTotal, occupational and leisure-time physical activity were inversely associated with clustered metabolic risk, whereas sedentary time increased metabolic risk. Commuting physical activity was inversely associated with triacylglycerol. These findings suggest that increased physical activity in different domains and decreased sedentary time may have protective effects against metabolic risk in type 2 diabetes patients.

scholarly journals Effects of Vildagliptin and Metformin on Blood Pressure and Heart Rate Responses to Small Intestinal Glucose in Type 2 Diabetes

Diabetes Care ◽  
2017 ◽  
Vol 40 (5) ◽  
pp. 702-705 ◽  
Author(s):  
Tongzhi Wu ◽  
Laurence G. Trahair ◽  
Tanya J. Little ◽  
Michelle J. Bound ◽  
Xiang Zhang ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Heart Rate ◽  
Small Intestinal

Abstract 16709: Contrasting Influences of Renal Function on Blood Pressure and HbA1c Reductions With Empagliflozin in Patients With Type 2 Diabetes and Hypertension

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
David Cherney ◽  
Mark Cooper ◽  
Ilkka Tikkanen ◽  
Susanne Crowe ◽  
Odd Erik Johansen ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Renal Function ◽  
Controlled Trial ◽  
Phase Iii ◽  
Vascular Effects ◽  
Antihypertensive Medications ◽  
Urinary Glucose ◽  
The Impact

The sodium glucose cotransporter 2 inhibitor empagliflozin (EMPA) reduces HbA1c, weight and blood pressure (BP) in patients with type 2 diabetes (T2D). While glucose lowering with EMPA is dependent on renal function, the impact of chronic kidney disease (CKD) on BP reduction with EMPA is less well understood. Our aim was to determine if impaired renal function attenuates antihypertensive effects of EMPA. A Phase III randomized placebo (PBO)-controlled trial (EMPA-REG BP™) investigated the efficacy and safety of EMPA in patients with T2D and hypertension (defined as mean seated office systolic BP [SBP] 130-159 mmHg and diastolic BP [DBP] 80-99 mmHg at screening). Patients (mean [SD] age 60.2 [9.0] years, HbA1c 7.90 [0.74] %, 24-hour SBP 131.4 [12.3] and 24-hour DBP 75.0 [7.8] mmHg) received EMPA 10 mg (n=276), EMPA 25 mg (n=276) or PBO (n=271) once daily for 12 weeks. We assessed changes from baseline in mean ambulatory 24-hour SBP and HbA1c in subgroups by baseline eGFR (MDRD equation), adjusting for differences in baseline mean 24-hour SBP (for SBP analyses only), HbA1c, region, number of antihypertensive medications, treatment, eGFR and treatment by eGFR interaction between groups. In patients with normal renal function, or stage 2 or 3 CKD, EMPA significantly reduced HbA1c and mean 24-hour SBP vs PBO (Table). As expected, PBO-corrected HbA1c reductions with EMPA appeared to decrease with decreasing eGFR (Table). In contrast, PBO-corrected reductions in mean 24-hour SBP with EMPA mostly appeared to increase with decreasing eGFR (Table). Unlike HbA1c, mean 24-hour SBP reductions with EMPA in patients with T2D and hypertension appear to be greater in patients with lower eGFR, indicating that SBP modulation with EMPA may involve pathways other than urinary glucose excretion such as diuretic effects, weight loss, improved glycemic control, reduced arterial stiffness or direct vascular effects.

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