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Diabetic patients with essential hypertension treated with amlodipine

blood pressure and arterial stiffness effects of canagliflozin or perindopril

Ramirez, Agustin J.a,b; Sanchez, Maria J.a; Sanchez, Ramiro A.a,b

doi: 10.1097/HJH.0000000000001907

Introduction: Hypertension control reduces cardiovascular and renal risks in type 2 diabetes. Sodium–glucose cotransporter-2 inhibitors prevent renal glucose reabsorption and decrease glucose plasma levels, blood pressure (BP) and weight reduction. Treatment of hypertension and sodium–glucose cotransporter-2 are able to improve arterial stiffness.

Aims: To evaluate, in patients with type 2 diabetes and hypertension, the effects of 6 months treatment with canagliflozin, or perindopril, an angiotensin converting enzyme inhibitor, on central BP and carotid–femoral pulse wave velocity (cfPWV).

Methods: Thirty type 2 diabetic patients with hypertension taking amlodipine, 10 mg daily, and metformin, 750–2000 mg daily, were randomized and a third medication was added: canagliflozin, 300 mg daily (n = 15, nine women, mean age: 63 ± 8 years), or perindopril, 10 mg daily (n = 15, five women, mean age 59 ± 4 years), for 6 months. Ambulatory BP monitoring was assessed at baseline and after 3 and 6 months of treatment, whereas cfPWV was measured before and after 6 months of treatment. Plasma fasting glucose, glycated hemoglobin, creatinine, plasma and urinary sodium and potassium were also measured.

Results: Both treatments significantly reduced BP and cfPWV. Only canagliflozin maintained the PWV action after adjusting for BP values and reduced glycemia, glycated hemoglobin and 24 h urinary sodium. Other security laboratory parameters, including gluthamic oxaloacetic transaminase, gluthamic piruvic transaminase; and bilirubin failed to show any change.

Conclusion: Canagliflozin reduced BP and improve arterial stiffness, independently of the BP effect. These two conditions could explain the cardiovascular protection observed with canagliflozin compared with perindopril.

aFoundation for Study of Hypertension and Cardiovascular Risk

bHypertension and Metabolic Unit, University Hospital, Favaloro Foundation, Buenos Aires, Argentina

Correspondence to Agustin J. Ramirez, Arterial Hypertension and Metabolic Unit, University Hospital, Fundación Favaloro, Belgrano 1782 P: 4, 1093 Buenos Aires, Argentina. Tel: +54 11 4378 1337; fax: +54 11 4378 1397; e-mail:

Abbreviations: ABPM, ambulatory blood pressure monitoring; ACEI, angiotensin converting enzyme inhibitor; BP, blood pressure; CCB, calcium channel blocker; cfPWV, carotid–femoral pulse wave velocity; CVR, cardiovascular risk; HbA1c, glycated hemoglobin; RAAS, renin–angiotensin–aldosterone system; SGLT2, sodium–glucose cotransporter-2; T1DM, type 1 diabetes mellitus; T2DM, type 2 diabetes mellitus

Received 8 January, 2018

Accepted 18 July, 2018

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