SGLT2 inhibitor improves vascular function parameters in patients with HF

Effects of the sodium-glucose cotransporter 2 inhibitor empagliflozin on vascular function in patients with chronic heart failure

Literature - Kolwelter J, Bosch A, Jung S et al. - ESC Heart Fail. 2021 Sep 20. doi: 10.1002/ehf2.13622.

Introduction and methods

Aim of the study

SGLT2 inhibitors reduce cardiorenal outcomes and HF hospitalizations in patients with HF. However, the underlying mechanisms of the effects of SGLT2 inhibitors remain unclear. This study aimed to investigate the effects of empagliflozin on vascular function in patients with HF.

Study design

This investigator initiated, double-blind, randomized, phase II clinical study included a total of 74 patients with HF NYHA II-III and EF≤49%. Patients were randomized in a 2:1 ratio to receive either empagliflozin 10 mg once daily or placebo for 3 months. Vascular parameters such as central SBP (cSBP), central pulse pressure (cPP), pulse wave velocity (PWV), forward and reflected pressure pulse height (FPH and RPH) were measured at baseline and after 1 and 3 months.

Main results

Under office conditions, cSBP, cPP, FPH and RPH were improved after 1 month and after 3 months in patients in the empagliflozin group, compared to baseline (1 month: cSBP -6.4 ± 8.3 mmHg, P<0.001, cPP -3.0 ± 6.6 mmHg, P=0.004, FPH -2.5 ± 4.5 mmHg, P=0.001, RPH -1.6 ± 3.0 mmHg, P=0.001; 3 months: cSBP -4.6 ± 8.4 mmHg, P=0.001, cPP -3.1 ± 4.8 mmHg, P<0.001, FPH -1.7 ± 3.7 mmHg, P=0.004, RPH -1.4 ± 2.5 mmHg, P=0.001).
Patients in the empagliflozin group had a significant improvement in cSBP (P=0.019) and FPH (P=0.035) after 1 months of treatment and in cPP (P=0.030) after 3 months of treatment under resting conditions, compared to patients in the placebo group.
24h ambulatory measurements showed that cSBP and cPP were improved after 1 and 3 months of treatment in the empagliflozin group, compared to baseline (1 month: cSBP -4.8 ± 10.1 mmHg, P=0.003, cPP -2.0 ± 5.7 mmHg, P=0.026; 3 months: cSBP -4.7 ± 9.0 mmHg, P=0.002, cPP -2.1 ±6.4 mmHg, P=0.044).
Patients in the empagliflozin group had a greater decrease in 24h ambulatory cSBP (P=0.027) and 24h ambulatory PWV (P=0.021) after 3 months compared to patients in the placebo group.

Conclusion

This phase II study showed that empagliflozin improved vascular function parameters in patients with HF under office conditions and in 24h ambulatory measurements compared to baseline as well as compared to placebo.

Find this article online at ESC Heart Fail.