Ipragliflozin tied to long-term reduction in BP in diabetes patients: PROTECT trial analysis

The study showed that ipragliflozin treatment lowered BP as compared to the control treatment throughout the 24-month follow-up period. A reduction in blood pressure correlated with weight loss, which the researchers suggest, "might be one of the mechanisms for the BP lowering effects of SGLT2 inhibitors."

"Ipragliflozin treatment modestly reduced systolic BP over the follow-up period of 24 months as compared to the control group (-3.6 mm Hg)," the researchers reported.

Previous studies have shown that sodium-glucose cotransporter-2 (SGLT2) inhibitors have a BP-lowering effect, but there is a lack of relevant long-term data. Therefore, Atsushi Tanaka, Department of Cardiovascular Medicine, Saga University, Saga, Japan, and colleagues aimed to assess the effect of SGLT2 inhibitor ipragliflozin on blood pressure, and associations between BP lowering and changes in cardiometabolic variables in patients with diabetes.

The team conducted a sub-analysis of the PROTECT trial, a randomized, multicenter, open-label study to assess if ipragliflozin delays carotid atherosclerosis in patients with type 2 diabetes.

Participants were randomized to ipragliflozin and control groups. The primary endpoint of the study was determined as the trajectory of systolic BP over 24 months. The researchers also evaluated correlations between systolic BP changes and cardiometabolic variables. In each study group, a total of 232 eligible participants with well-balanced baseline characteristics were included.

The study led to the following findings:

• Throughout the 24-month study period, mean systolic BP was lower in the ipragliflozin group.
• At 24 months, a between-group difference (ipragliflozin minus control) in mean systolic BP change from baseline was −3.6 mmHg, and the reduction in systolic BP in the ipragliflozin group was consistent across subgroups examined.
• Changes in systolic BP significantly correlated with those in body mass index in the ipragliflozin group, while no significant correlations with other cardiometabolic variables tested were observed.

"Throughout the 24-month follow-up period, Ipragliflozin treatment was associated with BP reduction as compared to control treatment," the researchers wrote.

"BP reduction corresponded with weight loss, which might be one of the mechanisms for the BP lowering effect of SGLT2 inhibitors," they concluded.

Reference:

Saito, Y., Tanaka, A., Imai, T., Nakamura, I., Kanda, J., Matsuhisa, M., Uehara, H., Kario, K., Kobayashi, Y., & Node, K. (2023). Long-term effects of ipragliflozin on blood pressure in patients with type 2 diabetes: Insights from the randomized PROTECT trial. Hypertension Research, 1-9. https://doi.org/10.1038/s41440-023-01494-6