Comparative Effects of Dapagliflozin and Empagliflozin on Blood Pressure and Cardiac Function in Hypertensive Patients with Heart Failure with Reduced Ejection Fraction in South Asian Population: A 24-Week Prospective Study from Pakistan

Objectives: To compare longitudinal changes in blood pressure (BP), left ventricular ejection fraction (LVEF), and functional class in hypertensive patients with heart failure with reduced ejection fraction (HFrEF) treated with dapagliflozin or empagliflozin. Methods: This prospective, single-center observational study was conducted at the Kashmir Institute of Cardiology, Mirpur, Azad Kashmir (May 2024–Dec 2025). A total of 120 hypertensive HFrEF patients (LVEF ≤40%) were followed for 24 weeks after initiating dapagliflozin or empagliflozin, alongside guideline-directed medical therapy. Systolic (SBP) and diastolic (DBP) BP, LVEF, and New York Heart Association (NYHA) class were assessed at baseline, 4, 8, 12, and 24 weeks. Mixed-effects modeling and paired analyses were applied. Results: SBP declined significantly from baseline to week 24 (−4.33 mmHg; 95% CI −4.65 to −4.02; p<0.001), with no difference between dapagliflozin and empagliflozin (p=0.566). DBP decreased by −1.89 mmHg (95% CI −2.14 to −1.64; p<0.001). Mean LVEF improved by +3.4% (95% CI 3.1–3.7; p<0.001), and NYHA class improved significantly by at least one grade in 81% of patients (p<0.001). Readmission (25.8%) and urinary tract infection (UTI) rates (6.6%) were low and comparable between treatments. Conclusion(s): Dapagliflozin and empagliflozin demonstrated comparable and clinically meaningful improvements in BP, LVEF, and functional status with favorable safety profiles. These findings support the routine incorporation of SGLT2 inhibitors into hypertensive HFrEF management, particularly in resource-limited South Asian settings. These results highlight comparable hemodynamic and functional benefits of both agents, reinforcing a class effect of SGLT2 inhibitors.