Different Effects of Canagliflozin and Perindopril in the Improvement of Arterial Stiffness in Type 2 Diabetic Patients

Abstract

Introduction: In type 2 diabetic patients (DM), after 6 months under perindopril or Canagliflozin, we previously reported a significant cf-PWV improvement related to high serum uric acid (SUA), stronger than the observed with blood pressure.Aims: To evaluate, in DM patients with arterial hypertension and normal renal function, the effects of canagliflozin or perindopril on SUA, 24hs ambulatory BP monitoring (ABPM) and cf -PWV.Methods: For 6 months, 20patients with DM and hypertension (59±4y; 10 females) received Metformin 2000mg, Amlodipine 10mg and Canagliflozin 300mg daily. Other 20 type 2 diabetic patients (62±4y, 8 female) received Metformin 2000mg, Amlodipine 10mg and Perindopril10mg daily. Parameters evaluated: HbA1C, fasting blood glucose level, glomerular filtration rate, SUA, urine uric acid excretion (urUA), 24h ABPM and cf-PWV. All evaluations were determined at baseline and after a 6-month continued treatment.Results: After 6 months treatment, Canagliflozin induced a decrease in cf-PWV (12.0±0.67 to 8.5±0.45m/sec, p<0.001), HbA1C (8.5±0.11 to 7.0±0.09%, p<0.001), SUA (7.9±0.22 to 6.9±0.45mg%, p<0.05) and ABPM (142.0±2.04/99.0±1.34 to 134.0±2.01/85.0±1.57mmHg, p<0.001). Perindopril only reduced ABPM (140.0±2.10/95.0 to 133.0±1.57/84.0±1.79mmHg, p<0.001) and cf-PWV (11.6±0.89 to 8.0±0.45m/sec, p<0.05). Only under Canagliflozin the urUA increased (350.0±4.47 to 580.0±6.71mg/24hs, p<0.001). A strong correlation was found between variations in SUA and cf-PWV(r: 0.69, p<0.025),showing that for each 1mg% reduction in SUA there is a decrease of 0.88m/sec in PWV.Conclusions: Canagliflozin and Perindopril ameliorates arterial stiffness in patients with type 2 DM and hypertension by reducing SUA that seems related, among other mechanisms, with a vascular intrinsic effect.