Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands; The George Institute for Global Health, Sydney, New South Wales, Australia.
Nephrology, Dialysis and Renal Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy.
Am Heart J. 2024 Apr;270:125-135. doi: 10.1016/j.ahj.2024.02.006. Epub 2024 Feb 15.
Sodium-glucose cotransporter 2 inhibitors decrease blood pressure in patients with type 2 diabetes, but the consistency and magnitude of blood pressure lowering with dapagliflozin in patients with chronic kidney disease (CKD) is unknown. We conducted a prespecified analysis of the DAPA-CKD trial to investigate the effect of dapagliflozin on systolic blood pressure (SBP) in patients with CKD, with and without type 2 diabetes.
A total of 4304 adults with baseline estimated glomerular filtration rate (eGFR) 25-75 mL/min/1.73m and urinary albumin-to-creatinine ratio (UACR) 200-5000 mg/g were randomized to either dapagliflozin 10 mg or placebo once daily; median follow-up was 2.4 years. The primary endpoint was a composite of sustained ≥50% eGFR decline, end-stage kidney disease, or death from a kidney or cardiovascular cause. Change in SBP was a prespecified outcome.
Baseline mean (SD) SBP was 137.1 mmHg (17.4). By Week 2, dapagliflozin compared to placebo reduced SBP by 3.6 mmHg (95% CI 2.8-4.4 mmHg), an effect maintained over the duration of the trial (2.9 mmHg, 2.3-3.6 mmHg). Time-averaged reductions in SBP were 3.2 mmHg (2.5-4.0 mmHg) in patients with diabetes and 2.3 mmHg (1.2-3.4 mmHg) in patients without diabetes. The time-averaged effect of dapagliflozin on diastolic blood pressure (DBP) was 1.0 mmHg (0.6-1.4 mmHg); 0.8 mmHg (0.4-1.3 mmHg) in patients with diabetes and 1.4 mmHg (0.7-2.1 mmHg) in patients without diabetes. Benefits of dapagliflozin on the primary composite and secondary endpoints were evident across the spectrum of baseline SBP and DBP.
In patients with CKD and albuminuria, randomization to dapagliflozin was associated with modest reductions in systolic and diastolic BP.
钠-葡萄糖共转运蛋白 2 抑制剂可降低 2 型糖尿病患者的血压，但在慢性肾脏病（CKD）患者中，达格列净降低血压的一致性和幅度尚不清楚。我们对 DAPA-CKD 试验进行了预先设定的分析，以研究达格列净对 CKD 患者（伴或不伴 2 型糖尿病）收缩压（SBP）的影响。
共纳入 4304 例基线估算肾小球滤过率（eGFR）为 25-75ml/min/1.73m 且尿白蛋白/肌酐比值（UACR）为 200-5000mg/g 的成年人，随机分为达格列净 10mg 或安慰剂每日一次；中位随访时间为 2.4 年。主要终点是持续 eGFR 下降≥50%、终末期肾病或因肾脏或心血管原因死亡的复合终点。SBP 的变化是一个预先设定的结果。
基线平均（SD）SBP 为 137.1mmHg（17.4）。与安慰剂相比，达格列净在第 2 周时降低 SBP 3.6mmHg（95%CI 2.8-4.4mmHg），这种效果在整个试验期间持续存在（2.9mmHg，2.3-3.6mmHg）。SBP 的时间平均降低幅度在糖尿病患者中为 3.2mmHg（2.5-4.0mmHg），在非糖尿病患者中为 2.3mmHg（1.2-3.4mmHg）。达格列净对舒张压（DBP）的时间平均作用为 1.0mmHg（0.6-1.4mmHg）；在糖尿病患者中为 0.8mmHg（0.4-1.3mmHg），在非糖尿病患者中为 1.4mmHg（0.7-2.1mmHg）。达格列净在主要复合终点和次要终点的获益在整个基线 SBP 和 DBP 范围内都有体现。
在 CKD 和白蛋白尿患者中，随机分配至达格列净组可使收缩压和舒张压适度降低。
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