| Popis: |
Background: The selective sodium-glucose cotransporter 2 (SGLT-2) inhibitor empagliflozin leads to improved cardiovascular, renal and heart failure outcome in secondary prevention. To better understand these effects, we examined vascular function and central hemodynamics. Methods: In this prospective, double-blind, randomized, placebo-controlled, crossover study 76 patients with untreated type 2 diabetes were randomized to empagliflozin 25 mg orally once daily or placebo. After 6 weeks of treatment with either empagliflozin or placebo and 1 week wash-out-phase, patients crossed over to the other treatment. Central hemodynamics and vascular function were assessed by central systolic blood pressure (BP), central pulse pressure, forward and backward wave amplitude under office (Sphygmocor, AtCor, Australia) as well as ambulatory conditions (Mobilograph, IEM, Aachen). Results: Treatment with empagliflozin reduced central systolic BP (114 ± 12 vs. 119 ± 14 mmHg, p < 0.001), central diastolic BP (74.4 ± 6.9 vs. 76.8 ± 8.2 mmHg, p = 0.004) and central pulse pressure (39.5 ± 9.9 vs. 42.2 ± 11 mmHg, p = 0.012) compared to placebo. Forward (p = 0.006) and backward (p = 0.026) reflection amplitude, assessed under office conditions, were also significantly lower with empagliflozin than with placebo. Under ambulatory conditions over 24-hours we also observed lower central systolic (117 ± 9 vs. 119 ± 9 mmHg, p = 0.059) and diastolic (79 ± 7 vs. 81 ± 7 mmHg, p = 0.011) BP after 6 weeks treatment with empagliflozin compared to placebo. Pulse wave velocity under ambulatory conditions was also reduced after 6 weeks with empagliflozin (p = 0.016). Conclusions: Our study demonstrated consistent significant improvements of vascular function and central hemodynamics with empagliflozin under office and ambulatory conditions. Our data support the concept that empagliflozin exerts beneficial effects on cardiovascular and heart failure outcome via improved vascular function. |
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