Effect Of Dapagliflozin On Nocturnal Blood Pressure And Circadian Rhythm Of Blood Pressure In Diabetic Patients With Hypertension

Objective:To investigate the effects of SGLT2 inhibitor(Dapagliflozin)on nocturnal blood pressure(BP)and the circadian rhythm of blood pressure in patients with type 2diabetes mellitus and hypertension.Method:A total of 76 patients with type 2 diabetes and hypertension who received treatment in our hospital from January 2021 to January 2022 were selected as the research objects.According to the different hypoglycemic therapy,the patients were divided into dapagliflozin group(35 cases),including 12 cases of lost follow-up and23 cases of completed experiment;the control group(41 cases),of which 18 were lost to follow-up and 23 were completed.Dapagliflozin group was additionally treated with dapagliflozin(10mg,once a day)on the basis of the original hypotensive therapy;the control group was treated with conventional hypoglycemic and hypertensive therapy,in which SGLT2 inhibitors should be excluded from the hypoglycemic therapy.The treatment lasted for about 3 months.The changes of nocturnal mean SBP and DBP,daytime mean SBP and DBP,24-hour mean SBP and DBP,the rate of nocturnal blood pressure drop and the circadian rhythm of BP in 2 groups before and after treatment were observed by 24-hour ambulatory blood pressure monitoring.Results:1.In dapagliflozin group,the mean nocturnal SBP and DBP,the mean daytime SBP and DBP,and the mean 24-hour SBP and DBP were significantly decreased compared with those before treatment(-21.3mm Hg,-12.0mm Hg,-18.0mm Hg,-11.1mm Hg,-18.5mm Hg,-11.2mm Hg);the differences were statistically significant(P < 0.05).In the control group,the mean nocturnal SBP and DBP,the mean daytime SBP and DBP,and the mean 24-hour SBP and DBP were also reduced significantly compared with those before treatment(-9.8mm Hg,-4.3mm Hg,-11.2mm Hg,-6.6mm Hg,-10.8mm Hg,-6.2mm Hg);the differences were statistically significant(P< 0.05).2.After treatment,the mean nocturnal SBP and 24-hour mean SBP in dapagliflozin group were reduced greater than control group(-11.5mm Hg,-7.7mm Hg,respectively;all P≤0.05).;however,the changes in mean nocturnal DBP,mean daytime SBP and DBP,24-hour DBP did not differ significantly between groups(P > 0.05).3.After treatment,the circadian rhythm of BP changed significantly in the dapagliflozin group.dipping status of BP increased by 8.7% and non-dipping status of BP increased by 13.1%;most of them were reversed by the reversal type of BP,and all of them were favorable changes.In the control group,there was a 4.3% decrease in non-dipper pattern and a 4.3% increase in reversal pattern of BP,there was no significant change in dipper pattern of BP;however,there was no significant difference in blood pressure profile between groups.4.In dapagliflozin group,the rate of nocturnal blood pressure drop increased by2.9% compared with that before treatment,with statistical significance(P < 0.05),while there was no significant difference in the control group(P > 0.05)and the difference between groups was also not significant(P > 0.05).5.After treatment,1 case of hypotension occurred in the dagagligin group,while no obvious adverse reactions occurred in the control group.There was no statistical significance in the incidence of adverse reactions between the two groups(P > 0.05)Conclusion:The addition of SGLT2 inhibitor(dapagliflozin)on the basis of conventional treatment can effectively reduce the nocturnal mean SBP and 24-hour mean SBP in diabetic patients with hypertension,especially in patients with nocturnal hypertension,and even have a beneficial effect on abnormal circadian rhythm of BP.