Cavalcante Pamela Nogueira, Barreto Joaquim, Kimura-Medorima Sheila T, Breder Ikaro, Nadruz Wilson, Sposito Andrei C
Atherosclerosis and Vascular Biology Laboratory (Aterolab), Division of Cardiology, State University of Campinas (Unicamp), Sao Paulo, Brazil.
Division of Cardiology, Department of Internal Medicine, Unicamp, Sao Paulo, Brazil.
Curr Med Res Opin. 2025 Jan;41(1):25-29. doi: 10.1080/03007995.2024.2442040. Epub 2024 Dec 20.
White coat effect (WCE) is a phenomenon linked to increased cardiovascular risk, where office blood pressure readings exceed home or ambulatory measurements. Excess weight and elevated blood pressure or glucose are associated with WCE in type 2 diabetes (T2D). This study compared dapagliflozin and glibenclamide on WCE in T2D patients under equivalent blood pressure and glucose control.
This analysis of the ADDENDA-BHS2 trial enrolled T2D patients with high cardiovascular risk, defined by stable coronary artery disease or subclinical carotid atherosclerosis. This single-center, open-label, randomized trial included 98 participants, randomized to 12 weeks of dapagliflozin or glibenclamide, in addition to metformin. Baseline blood pressure and glucose control were adjusted to maintain equivalence. This analysis focused on 85 participants with pre- and post-treatment 24-h ambulatory blood pressure data.
Despite blood pressure and glucose control, WCE was present in 28% of participants at baseline. Baseline-adjusted change in WCE on systolic BP showed median changes of -8.6 and 1.7 mmHg for dapagliflozin and glibenclamide groups, respectively ( = 0.048). This effect was not observed on diastolic blood pressure.
Dapagliflozin reduces WCE on systolic blood pressure compared to glibenclamide, even under equivalent blood pressure and glucose control.
The trial was registered at the Clinicaltrials.gov (NCT: 02919345).
白大衣效应（WCE）是一种与心血管风险增加相关的现象，即诊室血压读数超过家庭或动态血压测量值。超重以及血压或血糖升高与2型糖尿病（T2D）中的白大衣效应相关。本研究比较了达格列净和格列本脲在血压和血糖得到等效控制的T2D患者中对白大衣效应的影响。
对ADDENDA-BHS2试验进行的这项分析纳入了具有高心血管风险的T2D患者，高心血管风险由稳定型冠状动脉疾病或亚临床颈动脉粥样硬化定义。这项单中心、开放标签、随机试验纳入了98名参与者，除二甲双胍外，随机接受12周的达格列净或格列本脲治疗。对基线血压和血糖控制进行调整以维持等效性。该分析聚焦于85名有治疗前和治疗后24小时动态血压数据的参与者。
尽管血压和血糖得到控制，但28%的参与者在基线时存在白大衣效应。收缩压白大衣效应经基线调整后的变化显示，达格列净组和格列本脲组的中位数变化分别为-8.6和1.7 mmHg（P = 0.048）。在舒张压上未观察到这种效应。
即使在血压和血糖等效控制的情况下，与格列本脲相比，达格列净可降低收缩压的白大衣效应。
该试验在Clinicaltrials.gov（NCT：02919345）注册。
