A Case of Type 2 Diabetes with a Change from a Non-Dipper to a Dipper Blood Pressure Pattern by Dapagliflozin

Mori, Hiroko; Okada, Yosuke; Kawaguchi, Mayuko; Tanaka, Yoshiya

doi:10.7888/juoeh.38.149

Cited by 14 publications

(7 citation statements)

References 8 publications

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“…The reduction in nocturnal BP seen in this study is consistent with the suggestion that changes in BP during treatment with an SGLT2 inhibitor restore disrupted circadian BP rhythms, shifting patients with hypertension and diabetes from a nondipper to a dipper pattern. 30,31 Given the association between disrupted circadian BP patterns and cardiovascular events, [32][33][34][35] this is one plausible mechanism for the beneficial effects of SGLT2 inhibitor treatment on cardiovascular risk.…”

Section: Discussionmentioning

confidence: 99%

Effect of canagliflozin on nocturnal home blood pressure in Japanese patients with type 2 diabetes mellitus: The SHIFT‐J study

Kario

Okawara

Tomitani

et al. 2018

J of Clinical Hypertension

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Sodium‐glucose cotransporter 2 (SGLT2) inhibitors have beneficial effects on several cardiometabolic biomarkers, but this is not sufficient to fully explain the significant reduction in cardiovascular risk and mortality reported with SGLT2 inhibitor treatment in patients with diabetes mellitus. The 8‐week, randomized, open‐label SHIFT‐J study investigated the effects of adding canagliflozin vs intensified antihyperglycemic therapy on nocturnal home blood pressure (BP) in patients with poorly controlled type 2 diabetes and nocturnal BP on existing therapy. Patients were randomized to oral canagliflozin 100 mg/d or control (increased hypoglycemic dosage/addition of another hypoglycemic agent). The efficacy analysis included 78 patients (mean 69 years; 59% male). Nocturnal home systolic BP [HSBP] decreased by 5.23 mm Hg in the canagliflozin group and by 1.04 mm Hg in the control group (P = 0.078 for between‐group difference in change from baseline to week 8 [primary endpoint]); corresponding decreases in HSBP from baseline to week 4 were 5.08 and 1.38 mm Hg, respectively (P = 0.054). Reductions in morning HSBP from baseline to week 4 (−6.82 mm Hg vs −1.26 mm Hg, P = 0.038) and evening HSBP from baseline to week 8 (−8.74 mm Hg vs −2.36 mm Hg, P = 0.012) were greater in the canagliflozin group than in the control group. Body mass index (P < 0.001) and N‐terminal pro B‐type natriuretic peptide level (NT‐proBNP; P = 0.023) decreased more in the canagliflozin group than in the control group. Glycemic control improved comparably in both groups. Reduction of HSBP and NT‐proBNP level may be potential mechanism by which SGLT2 inhibitors reduce cardiovascular event risk.

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Section: Discussionmentioning

confidence: 99%

Effect of canagliflozin on nocturnal home blood pressure in Japanese patients with type 2 diabetes mellitus: The SHIFT‐J study

Kario

Okawara

Tomitani

et al. 2018

J of Clinical Hypertension

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“…<10% reduction in the asleep compared with the awake mean BP) is frequently observed in T2DM patients and is associated with a higher CV risk [90]. In this context, dapagliflozin was found to convert BP pattern from that of "non-dipper" to "dipper" in T2DM [91]. Luseogliflozin was also shown to exert a similar effect on the BP pattern, converting it from "non-dipper" to "dipper" in an animal study [92].…”

Section: Blood Pressure (Bp)mentioning

confidence: 92%

Sodium-glucose Cotransporter 2 Inhibitors (SGLT2i): Their Role in Cardiometabolic Risk Management

Katsiki

Mikhailidis

Theodorakis

2017

CPD

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“…Recently, a clinical case study examined the effect of dapagliflozin (5 mg/day) in patients with type 2 diabetes who exhibited a non-dipper type (sleep-time mean SBP > 90% of awake-time mean) of hypertension. Administration of dapagliflozin significantly decreased BP and altered the circadian dipping pattern of BP, from a non-dipper type to a dipper type (sleep-time mean SBP ≤ 90% of awake-time mean) ( 46 ). Another empagliflozin clinical trial also revealed that the reduction in BP was greater during sleep-time, than during wake-time, in type 2 diabetes patients with non-dipper hypertension ( 47 ).…”

Section: Effects Of Sglt2 Inhibitors On Dipping Pattern Of Bpmentioning

confidence: 99%

The Effects of Sodium-Glucose Cotransporter 2 Inhibitors on Sympathetic Nervous Activity

et al. 2018

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The EMPA-REG OUTCOME study revealed that a sodium-glucose cotransporter 2 (SGLT2) inhibitor, empagliflozin, can remarkably reduce cardiovascular (CV) mortality and heart failure in patients with high-risk type 2 diabetes. Recently, the CANVAS program also showed that canagliflozin, another SGLT2 inhibitor, induces a lower risk of CV events. However, the precise mechanism by which an SGLT2 inhibitor elicits CV protective effects is still unclear. Possible sympathoinhibitory effects of SGLT2 inhibitor have been suggested, as significant blood pressure (BP) reduction, following treatment with an SGLT2 inhibitor, did not induce compensatory changes in heart rate (HR). We have begun to characterize the effects of SGLT2 inhibitor on BP and sympathetic nervous activity (SNA) in salt-treated obese and metabolic syndrome rats, who develop hypertension with an abnormal circadian rhythm of BP, a non-dipper type of hypertension, and do not exhibit a circadian rhythm of SNA. Treatment with SGLT2 inhibitors significantly decreased BP and normalized circadian rhythms of both BP and SNA, but did not change HR; this treatment was also associated with an increase in urinary sodium excretion. Taken together, these data suggest that an SGLT2 inhibitor decreases BP by normalizing the circadian rhythms of BP and SNA, which may be the source of its beneficial effects on CV outcome in high-risk patients with type 2 diabetes. In this review, we briefly summarize the effects of SGLT2 inhibitors on BP and HR, with a special emphasis on SNA.

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A Case of Type 2 Diabetes with a Change from a Non-Dipper to a Dipper Blood Pressure Pattern by Dapagliflozin

Cited by 14 publications

References 8 publications

Effect of canagliflozin on nocturnal home blood pressure in Japanese patients with type 2 diabetes mellitus: The SHIFT‐J study

Effect of canagliflozin on nocturnal home blood pressure in Japanese patients with type 2 diabetes mellitus: The SHIFT‐J study

Sodium-glucose Cotransporter 2 Inhibitors (SGLT2i): Their Role in Cardiometabolic Risk Management

The Effects of Sodium-Glucose Cotransporter 2 Inhibitors on Sympathetic Nervous Activity

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