The influence of long-term administration of SGLT2 inhibitors on blood pressure at the office and at home in patients with type 2 diabetes mellitus and chronic kidney disease

Abstract

The decrease in blood pressure is thought to play an important role for the renoprotective effects of sodium-glucose cotransporter 2 inhibitors in patients with diabetes mellitus. However, their influence on blood pressure at home has not been well studied. The aim of this study is to clarify how long-term use of sodium-glucose cotransporter 2 inhibitors influence on blood pressure both at the office and at home, and the kidney function. We retrospectively analyzed 102 patients with type 2 diabetes mellitus and chronic kidney disease to whom sodium-glucose cotransporter 2 inhibitors were administered for more than 1 year, and whose blood pressure were monitored both at the office and at home. The blood pressure at the office and at home significantly decreased, and there was a significant positive correlation between both blood pressure values. Controlled, white-coat, and sustained hypertension were observed in 9.8%, 14.7%, and 55.9% of the patients at the beginning of the treatment, which changed to 16.7%, 15.7%, and 48.0% at the time of the survey, however, the ratio of masked hypertension was not changed (19.6%). The cutoff value of mean arterial pressure at home after treatment for the improvement of urine albumin to creatinine ratio was 92.0 mm Hg, with 54.1% of sensitivity and 60.0% of specificity. Sodium-glucose cotransporter 2 inhibitors can be useful for the strict management of blood pressures both at the office and at home. The decrease in blood pressure at home by this treatment might be related to the improvement of diabetic nephropathy.

FIGURE 1

Distribution of BP categories at the initiation of SGLT2I treatment and at the survey. BP, blood pressure; Controlled, controlled hypertension group (BP at the office <130/80 and BP at home <125/75); Masked, masked hypertension group (BP at the office <130/80 and BP at home ≥125/75); SGLT2I, Sodium–glucose cotransporter 2 inhibitor; Sustained, sustained hypertension group (BP at the office ≥130/80 and BP at home ≥125/75); White coat, white‐coat hypertension group (BP at the office ≥130/80 and BP at home <125/75)

FIGURE 2

Changes in MAP at the office and at home with SGLT2 inhibitor treatment depending on BP status. BP, blood pressure; Controlled, controlled hypertension group (BP at the office <130/80 and BP at home <125/75); Masked, masked hypertension group (BP at the office <130/80 and BP at home ≥125/75); SGLT2I, Sodium–glucose cotransporter 2 inhibitor; Sustained, sustained hypertension group (BP at the office ≥130/80 and BP at home ≥125/75); White coat, white‐coat hypertension group (BP at the office ≥130/80 and BP at home <125/75)

FIGURE 3

Correlation of BP changes at the office and BP at home. BP, blood pressure; ΔMAP; change in mean arterial pressure

FIGURE 4

The ROC curve to determine the possibility of improvement of MAP at office. MAP, mean arterial pressure; ROC, Receiver operating characteristic

FIGURE 5

The ROC curve to determine the possibility of improvement of ACR. ACR, urine albumin to creatinine ratio; ROC, Receiver operating characteristic