Mechanisms underlying the blood pressure‐lowering effects of empagliflozin, losartan and their combination in people with type 2 diabetes: A secondary analysis of a randomized crossover trial
Authors' conclusion
In people with T2D, SGLT2 inhibition in combination with an ARB had a larger blood pressure-lowering effect versus placebo than either of the drugs alone. Our data further suggest that the mechanisms underlying these blood pressure reductions at least partially differ between these agents.
Study context
- Population
- People with T2D (age 66 ± 6 years; BMI 31.0 ± 3 kg/m²; eGFR 90 ml/min/1.73m2)crossover
- Participants
- 24 people
- Comparison
- Empagliflozin, losartan and their combination vs placebo
- Primary endpoint
- Blood pressure (systolic blood pressure (SBP))
- Follow-up
- 1 week
Methodological detailsdouble-blind, 4-week washout periods
- Double-blind
- 4-week washout periods
Primary result
As reported in the abstract
SBP
Placebo
139
mmHg
Difference, mmHg (95% CI)
Empagliflozin + losartanvs Empagliflozinlarger SBP-lowering effect with combination
−7(−12 to −2)
Empagliflozin + losartanvs Losartannumerically larger effect with combination
−3(−8 to 2)
- Empagliflozin vs Placebo · lower with Empagliflozin
- reduction 8 mmHg; P = 0.001
- Losartan vs Placebo · lower with Losartan
- reduction 12 mmHg; P = 0.001
- Empagliflozin + losartan vs Placebo · lower with Empagliflozin + losartan
- reduction 15 mmHg; P < 0.001
Further findings
Mechanisms: Sympathetic nervous system (SNS) activity, arterial stiffness, volume
- Empagliflozin reduced SNS activity, arterial stiffness and extracellular fluid, while increasing serum albumin
- Losartan reduced SNS activity and arterial stiffness
- Combination induced volume contraction variables, with reduced SNS activity and arterial stiffness
Original publication
Mechanisms underlying the blood pressure‐lowering effects of empagliflozin, losartan and their combination in people with type 2 diabetes: A secondary analysis of a randomized crossover trial. Diabetes Obes Metab. Published 27 September 2022. doi:10.
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