| Background and purpose:Heart failure with preserved ejection fraction(HFp EF)is a type of heart failure characterized by cardiac diastolic dysfunction.Foreign studies have shown that HFp EF accounts for about 40%-71% of all heart failure.Hypertension and diabetes(Type 2diabetes mellitus,T2DM)are the main risk factors of HFp EF.However,due to the relatively limited understanding of HFp EF,there is no satisfactory treatment to improve its prognosis.Sodium-glucose cotransporter 2 inhibitor(SGLT2i)is a new hypoglycemic drug with clear cardiovascular protection.DAPA-HF and EMPERORReduced studies show that SGLT2 inhibitor can reduce the risk of heart failure exacerbation in patients with HFr EF with or without T2 DM.However,for patients with T2 DM complicated with hypertension,there is no relevant clinical study to prove whether dapagliflozin can improve their left ventricular diastolic function and improve the prognosis of HFp EF.The purpose of this study was to investigate the effects of dapagliflozin on left ventricular diastolic function,blood pressure and uric acid in patients with T2 DM complicated with hypertension.In order to provide basis for clinical benefit of T2 DM patients with hypertension.Method:The clinical data of patients with hypertension complicated with T2 DM and left ventricular diastolic dysfunction of at least grade one in the the Fourth Affiliated Hospital of Nanchang University from January 2020 to December 2021 were retrospectively analyzed.60 cases were treated with Dapagliflozin and other conventional hypoglycemic drugs(insulin,acarbose,dimethylbiguanide,gliclazide /glimepiride)for 6 months and with complete data before and after treatment,According to different treatment measures,they were divided into 30 cases in the Dapagliflozin group and 30 cases in the control group.On the basis of conventional hypoglycemic drugs,Dapagliflozin 10 mg per day was added to control blood glucose in the observation group,and conventional hypoglycemic drugs were used in the control group.After 6 months of treatment,the indexes of left ventricular diastolic function of the two groups were compared: early diastolic velocity of mitral valve orifice e,early diastolic movement velocity e’,E/e’,left ventricular end diastolic diameter(LVEDD),left ventricular mass index(LVMI),improvement of left ventricular diastolic function,body mass index(BMI),systolic blood pressure(SBP),diastolic blood pressure(DBP),pulse pressure,fasting blood glucose(FBG),2-hour postprandial blood glucose(PBG)Glycosylated hemoglobin(Hb A1c),UA,high density lipoprotein cholesterol(HDL-C),cholesterol(TC),triglyceride(TG)and low density lipoprotein cholesterol(LDL-C).Result:1.At baseline,there was no difference in age,sex,weight,BMI,blood glucose,blood lipid,blood pressure and LVEDD,LAD and E/e’ between the two groups(P >0.05).2.After 6 months of treatment,the systolic blood pressure,diastolic blood pressure,pulse pressure,body weight and BMI of Dapagliflozin group decreased significantly compared with the baseline(P < 0.05),but there was no significant difference between the control group and the baseline(P > 0.05).Changes of systolic blood pressure,diastolic blood pressure,pulse pressure,body weight,BMI and baseline between the two groups(Δ SBP、 Δ DBP 、 ΔPulse pressure 、ΔWeight ΔBMI),the difference was statistically significant(P < 0.05).3.After 6 months of treatment,FBG,PBG,Hb A1 c and UA in Dapagliflozin group were significantly lower than those at baseline(P<0.05).There was no significant difference in FBG,PBG and UA between the control group and the baseline(P> 0.05),and Hb A1 c was significantly lower than the baseline(P<0.05).HDL-C increased in Dapagliflozin group,and there was significant difference compared with baseline(P<0.05).There was no significant difference in HDL-C between the control group and baseline(P>0.05);There was no significant difference in TC,TG and LDL-C between the two groups and baseline(P>0.05).Changes of FBG,PBG,Hb A1 c,TC,TG,HDLC,LDL-C and UA compared with baseline(ΔFBG、Δ PBG、ΔHb A1c、ΔTC、ΔTG、ΔHDL-C、 ΔLDL-C 、ΔUA)was compared between the two groups,There was no significant difference in ΔFBG、 ΔPBG、 ΔHb A1c、ΔTC、ΔTG 、ΔLDL-C between the two groups(P>0.05).There was significant difference in ΔHDL-C、 ΔUA between the two groups(P < 0.05).4.Effect on left ventricular diastolic function: after 6 months of treatment,E/e’,e’,LVMI and LVEDD in Dapagliflozin group decreased compared with baseline,and the difference was statistically significant(P<0.05);There was no significant difference in E/e’,LVMI and LVEDD between the control group and baseline(P>0.05).Changes in E/e’,LVMI and baseline(ΔLVMI、ΔE/e’)between the two groups,the difference was statistically significant(P<0.05).The left ventricular diastolic function was improved in 16 patients and not improved in 14 patients in Dapagliflozin group,with an improvement rate of 53.33%;In the control group,the left ventricular diastolic function was improved in 8 people and not improved in 22 people,with an improvement rate of 26.67%.And the higher the grade of diastolic dysfunction,the better the improvement effect(P<0.05).Conclusion:Dapagliflozin can reduce body weight,BMI,blood pressure and uric acid levels,increase HDL-C,and improve left ventricular diastolic function in patients with T2 DM complicated with hypertension.The improvement effect is different in different levels of diastolic dysfunction.The higher the level of diastolic dysfunction,the better the improvement effect. |
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