PS-C31-5: COMPARISON OF THE BLOOD PRESSURE MANAGEMENT BETWEEN SODIUM GLUCOSE CO-TRANSPORTER 2 INHIBITORS AND GLUCAGON-LIKE PEPTIDE 1 RECEPTOR AGONISTS

Abstract

Background: Several large clinical studies using not only sodium-glucose co-transporter 2 inhibitors (SGLT-2is) but also glucagon-like peptide 1 receptor agonists (GLP-1Ras) showed the superiority on the renal outcome on patients with type 2 diabetes (T2DM). There is no direct comparison of renoprotective effects between these two drugs, further, the mechanism for the renoprotective effects is not fully understood. Our previous survey revealed the superiority of SGLT2i treatment for the renoprotective effects compared to GLP1Ra. We also reported the importance of the reduction of BP during treatment, however, there is no direct comparison between their BP lowering efficacies. Aim: This study aimed to compare the rates of achieving a target BP and the renal effects, with SGLT-2i and GLP-1Ra treatments, administered in Japanese patients with T2DM and poorly controlled BP. Methods: Kanagawa Physicians Association separately carried out retrospective surveys that included patients with T2DM receiving therapy with SGLT-2i or GLP-1Ra for more than one year. After excluding the patients who used both SGLT2i and GLP1Ra, 384 SGLT-2i- and 160 GLP-1Ra-treated patients, with a BP more than 130/80 mmHg, before treatment were included in this study. Propensity score (PS) for the SGLT2i treatment were calculated using logistic regression and the inverse probability weighting method with average effect for treatment (ATE) weight and the trimming of patients with 0.05 ≦ PS≦ 0.95. The BP control rates were compared using a generalized linear model. Results: In this study, the rage of the standardized difference between two treatments was form 0.02 to0.20. SGLT-2i treatment resulted in significantly higher BP control rates than GLP1Ra treatment (odds ratio [95%confidence interval] = 2.09 [1.08, 4.03], p = 0.03). Compared with GLP-1Ra-treated patients, SGLT-2i-treated patients had significantly larger decreases in diastolic BP, mean arterial pressure, and body weight (-3.8[-6.6, -1.1] mmHg, P = 0.006; -4.1[-7.2, -1.0] mmHg, P = 0.01; and -1.5 [-2.7, -0.4], P = 0.008, respectively) and increased annual estimated glomerular filtration rate (eGFR; 1.5 [0.05, 2.9] mL/min/1.73 m2/year, P = 0.04). Conclusion: In T2DM patients with poorly controlled BP, compared with GLP-1Ra, SGLT-2i treatment significantly improved BP management and increased eGFR. When the renoprotective effect is expected in the clinical practice, it is necessary to consider the degree of contribution to the achievement of BP control in addition to the characteristics of the drugs.