EFFECTS ON HOME BLOOD PRESSURE AND HEART RATE OF SEQUENTIALLY ADDING DULAGLUTIDE TO THERAPY IN PEOPLE WITH TYPE 2 DIABETES MELLITUS WHO HAD PREVIOUSLY BEEN RECEIVING EMPAGLIFLOZIN. (June 2018) - Misawa, T.
Abstract : Objective: Glucagon-like peptide-1 (GLP-1) receptor agonists, used to treat type 2 diabetes mellitus, have been reported to be associated with a small reduction in systolic blood pressure (SBP) and increases in heart rate (HR). However, for patients with type 2 diabetes mellitus (T2DM) at high cardiovascular risk who had previously been receiving 10 mg of sodium-glucose cotransporter 2 inhibitor empagliflozin once daily for one year, the effects are not known regarding the effects of once-weekly GLP-1 receptor agonist dulaglutide in addition to therapy on self-measured home blood pressure (BP) and heart rate (HR) at home. Design and method: We followed twelve consecutive T2DM patients (mean age: 68 years old, 4 men, mean BMI: 28.0 kg/m 2 ) with cardiovascular risk after adding 0.75 mg of dulaglutide once weekly, for three months. Home BP and HR were measured once every morning at home, using an oscillometric device. Results: The administration of empagliflozin induced significant (0.7 ± 0.8%) reductions of glycated hemoglobin (HbA1c) and significant (2.8 ± 2.5 kg) reductions of body weight (BW) during the first three months, and dulaglutide also significantly reduced HbA1c and BW from 7.4 ± 0.8% and 68.8 ± 10.2 kg at baseline to 6.3 ± 0.5% and 66.7 ± 11.0 kg at the end of the study, respectively (P < 0.01). For home blood pressure, dulaglutide significantly reduced SBP from 128 ± 10 mmHg at baseline to 124 ± 10 mmHg at the fourth week (4W) of the administration (P < 0.05). SBP achieved the target home blood pressure goal at 4W, and was maintained during the study (8W: 122 ± 10 mmHg, P < 0.01). In the case of empagliflozin, at 1W of the administration it significantly reduced SBP from 130 ± 11 mmHg at baseline to 126 ± 11 mmHg (P < 0.01) (12W: 124 ± 10 mmHg). However, there was no change in diastolic blood pressure (DPB) upon administration of empagliflozin or dulaglutide (DPB: 71 ± 6 mmHg at baseline). Dulaglutide significantly increased HR from 68 ± 10 beats per minute (bpm) at baseline to 72 ± 10 bpm at 8W (P < 0.01), although there was no significant change in HR upon administration of empagliflozin. Conclusions: Dulaglutide significantly and slowly reduced home SBP with increase of HR at home, compared with empagliflozin.