THE EFFECT OF DAPAGLIFLOZIN ON BLOOD PRESSURE IN ELDERLY PATIENTS WITH OBESITY, ARTERIAL HYPERTENSION AND POORLY CONTROLLED TYPE 2 DIABETES

Objective: To evaluate the effect of dapagliflozin (D) versus metformin (M) on blood pressure (BP) and glycaemic control in elderly patients with obesity, arterial hypertension (AH), and poorly controlled type 2 diabetes mellitus (T2DM), in addition to standard antihypertensive therapy. Design and method: A total of 81 elderly patients with stage II AH and poorly controlled T2DM were enrolled (mean fasting plasma glucose (FPG): 8.15 ± 1.35 mmol/L, glycated haemoglobin (HbA1c): 8.14 ± 1.4%, mean age: 69 ± 3.2 years, mean BP: 161/94 ± 3.5/2.3 mm Hg, body mass index (BMI): 33.4 ± 2.7 kg/m2, disease duration: 10.6 ± 2.7 years). The control group included 40 patients who received metformin 1000 mg once daily, along with a single daily poly-pill containing perindopril 4 mg, amlodipine 10 mg, and indapamide 2.5 mg. The treatment group consisted of 41 patients who received dapagliflozin 10 mg once daily for 6 months, in addition to standard therapy. Results: Six months after starting the therapy, the following results were obtained: the dapagliflozin group showed more significant reductions in HbA1c (-1.95% vs -0.94%, p < 0.0001), FPG (-1.91 mmol/L vs -0.83 mmol/L), mean systolic BP (-11.4 mmHg vs -5.3 mmHg, p = 0.001), and mean diastolic BP (-6.6 mmHg vs -2.8 mmHg, p = 0.0043) compared to the control group. Final HbA1c levels were 6.21 ± 0.55% in the dapagliflozin group and 6.92 ± 0.18% in the control group (p < 0.05). Systolic BP was 132 ± 7.24 mm Hg in the dapagliflozin group and 143 ± 8.17 mm Hg in the control group (p < 0.05). Diastolic BP was 84.1 ± 3.7 mm Hg and 88.3 ± 4.1 mm Hg, respectively. No cases of hypoglycaemia or urinary tract infection were observed. Both groups showed slight decreases in BMI (31.3 ± 1.25 kg/m2vs 32.4 ± 1.27 kg/m2, respectively), though these changes were insignificant. Conclusions: the obtained data suggest that adding dapagliflozin to standard triple antihypertensive therapy in elderly patients with AH, obesity, and T2DM leads to a more significant reduction in BP and an improvement in glycaemic control.