Key result
Linagliptin added to stable doses of ACE inhibitors or ARBs did not significantly change 24-hour systolic blood pressure (mean difference -2.30 mmHg for ACE inhibitors) in patients with type 2 diabetes and albuminuria.
Why the study?
Pharmacological studies suggested a potential adverse interaction between ACE inhibitors and DPP-4 inhibitors leading to unfavorable hemodynamic changes, while few studies examined interactions between ARBs and DPP-4 inhibitors.
Does linagliptin affect blood pressure and heart rate in individuals with type 2 diabetes and albuminuria receiving ACE inhibitors or ARBs?
RCT (n=360)
Double-blind
Randomized
Yes
Does linagliptin affect blood pressure and heart rate in individuals with type 2 diabetes and albuminuria receiving ACE inhibitors or ARBs?
Effect estimate: Mean Difference -2.30 mmHg (95% CI -7.43, 2.84)
p-value: p=0.3789
Adding linagliptin to ACE inhibitors or ARBs does not cause adverse hemodynamic changes in patients with type 2 diabetes and albuminuria, supporting their concomitant use.
Supports safe co-administration with ACE inhibitors or ARBs without hemodynamic concerns; extends tolerability data in type 2 diabetes with albuminuria.
OBJECTIVE: Concomitant treatment with angiotensin-converting enzyme (ACE) inhibitors and dipeptidyl peptidase-4 (DPP-4) inhibitors is increasingly common. Pharmacological studies have suggested a potential adverse drug interaction between ACE inhibitors and DPP-4 inhibitors resulting in unfavorable hemodynamic changes; very few studies have examined such an interaction between angiotensin II receptor blockers (ARBs) and DPP-4 inhibitors. We investigated blood pressure (BP) and heart rate (HR) during treatment with the DPP-4 inhibitor linagliptin in individuals receiving either ACE inhibitors or ARBs in the MARLINA-T2D trial. METHODS: In this study, 360 individuals with type 2 diabetes and albuminuria receiving unchanged doses of ACE inhibitors or ARBs were randomized to linagliptin or placebo. Twenty-four-hour ambulatory BP monitoring, an exploratory endpoint, was conducted at baseline and after 24 weeks. RESULTS: Ambulatory BP monitoring data were available for 208 individuals (linagliptin: n = 111; placebo: n = 97). Baseline mean ± SD 24-h SBP and DBP were 132.5 ± 12.4 mmHg and 75.9 ± 9.4 mmHg, respectively; mean 24-h HR was 76.3 ± 10.1 bpm. At week 24, no overall effect of the DPP-4 inhibitor versus placebo was seen on mean 24-h SBP, DBP, or HR. Furthermore, in the subgroups receiving either an ACE inhibitor or an ARB, no effect on these hemodynamic parameters was seen as a result of concomitant DPP-4 inhibitor treatment. CONCLUSION: Adding linagliptin to treatment with ACE inhibitors or ARBs was not associated with any hemodynamic changes, supporting their concomitant use in individuals with type 2 diabetes and albuminuria.
No takes yet. Share an insight, caveat, or question.
Cooper et al. (2018) conducted an RCT in Type 2 diabetes and albuminuria (n=360). Linagliptin vs. Placebo was evaluated on Placebo-adjusted change from baseline in mean 24-h SBP in participants receiving ACE inhibitors (Mean Difference -2.30 mmHg, 95% CI -7.43, 2.84, p=0.3789). Linagliptin added to stable doses of ACE inhibitors or ARBs did not significantly change 24-hour systolic blood pressure (mean difference -2.30 mmHg for ACE inhibitors) in patients with type 2 diabetes and albuminuria.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: