Patients with lower BMI more likely to achieve target BP with SGLT2 inhibitors

"In patients with type 2 diabetes and chronic kidney disease, baseline BMI was associated with the antihypertensive effects of sodium-glucose cotransporter 2 inhibitors (SGLT2-I)," the researchers wrote in their study. "Patients in the lower baseline BMI group were more likely to achieve the target BP after treatment with SGLT2 inhibitors."

Sodium-glucose cotransporter 2 inhibitors are reported to have excellent antihypertensive effects in addition to its hypoglycemic effects. However, there is no information on whether BMI affects the antihypertensive effect of SGLT2 inhibitors. Therefore, Kazuo Kobayashi, Yokohama City University Graduate School of Medicine, Yokohama, Japan, and colleagues investigated the impact of baseline BMI on the achievement of target blood pressure with SGLT2-I treatment in Japanese patients with T2DM and CKD.

For this purpose, the researchers retrospectively evaluated 447 Japanese patients with T2D and CKD treated with SGLT2 inhibitors for at least 1 year. The primary outcome of the study was determined as achieving the target BP (<130/80 mmHg) after treatment with SGLT2 inhibitors. Patients were categorized into two groups according to a baseline BMI of 29.1 determined by receiver operating characteristic analysis and analyzed with propensity score matching in a cohort model. In each group, 130 patients were compared by propensity score matching.

The study led to the following findings:

• The target BP achievement rate was significantly higher in the BMI < 29.1 group than in the BMI ≥ 29.1 group (34% and 21%, respectively,).
• The odds ratio for achieving the target BP in the BMI ≥ 29.1 group was 0.50.
• The BMI < 29.1 group had significantly lower systolic and diastolic BPs after SGLT2-I treatment than the BMI ≥ 29.1 group.
• Only the BMI < 29.1 group showed a significant decrease in the logarithmic albumin-to-creatinine ratio from baseline after SGLT2-I treatment.

"In patients with type 2 diabetes and chronic kidney disease, pretreatment BMI affects the antihypertensive effect of SGLT2 inhibitors," the researchers concluded.

Reference:

Tsukamoto, S., Kobayashi, K., Toyoda, M., Hatori, N., Kanaoka, T., Wakui, H., Sakai, H., Furuki, T., Chin, K., Ito, S., Suzuki, D., Umezono, T., Aoyama, T., Nakajima, S., Hishiki, T., Hatori, Y., Hayashi, M., Shimura, H., Minagawa, F., . . . Kanamori, A. (2023). Pretreatment body mass index affects achievement of target blood pressure with sodium-glucose cotransporter 2 inhibitors in patients with type 2 diabetes mellitus and chronic kidney disease. Hypertension Research, 1-11. https://doi.org/10.1038/s41440-023-01464-y