Key result
In patients with type 2 diabetes and hypertension, 6 months of treatment with canagliflozin or perindopril similarly reduced carotid-femoral pulse wave velocity, while only canagliflozin significantly reduced serum uric acid.
Why the study?
To evaluate the effects of canagliflozin versus perindopril on serum uric acid, 24-hour ambulatory blood pressure monitoring, and cf-PWV in type 2 diabetic patients with hypertension and normal renal function.
Does canagliflozin compared to perindopril improve arterial stiffness and serum uric acid in hypertensive patients with type 2 diabetes?
RCT (n=40)
Randomized
Does canagliflozin compared to perindopril improve arterial stiffness and serum uric acid in hypertensive patients with type 2 diabetes?
Absolute Event Rate: 8.5% vs 8%
p-value: p=<0.001
Canagliflozin improves arterial stiffness in hypertensive type 2 diabetic patients similarly to perindopril, but uniquely reduces serum uric acid, which correlates with the vascular improvement.
Introduction: In type 2 diabetic patients (DM), after 6 months under perindopril or Canagliflozin, we previously reported a significant cf-PWV improvement related to high serum uric acid (SUA), stronger than the observed with blood pressure.Aims: To evaluate, in DM patients with arterial hypertension and normal renal function, the effects of canagliflozin or perindopril on SUA, 24hs ambulatory BP monitoring (ABPM) and cf -PWV.Methods: For 6 months, 20patients with DM and hypertension (59±4y; 10 females) received Metformin 2000mg, Amlodipine 10mg and Canagliflozin 300mg daily.Other 20 type 2 diabetic patients (62±4y, 8 female) received Metformin 2000mg, Amlodipine 10mg and Perindopril10mg daily.Parameters evaluated: HbA1C, fasting blood glucose level, glomerular filtration rate, SUA, urine uric acid excretion (urUA), 24h ABPM and cf-PWV.All evaluations were determined at baseline and after a 6-month continued treatment.Results: After 6 months treatment, Canagliflozin induced a decrease in cf-PWV (12.0±0.67 to 8.5±0.45m/sec,p<0.001),HbA1C (8.5±0.11 to 7.0±0.09%,p<0.001),SUA (7.9±0.22 to 6.9±0.45mg%,p<0.05) and ABPM (142.0±2.04/99.0±1.34 to 134.0±2.01/85.0±1.57mmHg,p<0.001).Perindopril only reduced ABPM (140.0±2.10/95.0 to 133.0±1.57/84.0±1.79mmHg,p<0.001) and cf-PWV (11.6±0.89 to 8.0±0.45m/sec,p<0.05).Only under Canagliflozin the urUA increased (350.0±4.47 to 580.0±6.71mg/24hs,p<0.001).A strong correlation was found between variations in SUA and cf-PWV(r: 0.69, p<0.025),showing that for each 1mg% reduction in SUA there is a decrease of 0.88m/sec in PWV.Conclusions: Canagliflozin and Perindopril ameliorates arterial stiffness in patients with type 2 DM and hypertension by reducing SUA that seems related, among other mechanisms, with a vascular intrinsic effect.
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Sanchez Ramiro A (2021) conducted an RCT in Type 2 diabetes mellitus and hypertension (n=40). Canagliflozin vs. Perindopril 10 mg daily was evaluated on Carotid-femoral pulse wave velocity (cf-PWV) at 6 months (p=<0.001). In patients with type 2 diabetes and hypertension, 6 months of treatment with canagliflozin or perindopril similarly reduced carotid-femoral pulse wave velocity, while only canagliflozin significantly reduced serum uric acid.
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