THE BODY MASS INDEX INFLUENCES THE ACHIEVEMENT RATIO OF TARGET BLOOD PRESSURE BY SODIUM-GLUCOSE COTRANSPORTER 2 INHIBITORS IN JAPANESE TYPE 2 DIABETES PATIENTS WITH CKD

Abstract

Objective: Some large clinical trials using sodium-glucose cotransporter 2 inhibitor (SGLT2i) revealed the superiority in the renal outcome in type 2 diabetes mellitus (T2DM) patients. We already reported that the decrease in blood pressure (BP) was closely related to the renoprotective effects and SGLT2i was useful for the BP management in T2DM patients. The aim of this study is to clarify how body mass index (BMI; kg/m2) influence the achievement ratio of target BP by using SGLT2i in Japanese T2DM patients. Design and method: We retrospectively assessed 447 patients with Japanese T2DM patients with chronic kidney disease (CKD) who underwent SGLT2i treatment for more than 1 year and whose BP at office was uncontrolled (<130/80mmHg) before SGLT2i treatment. We set the endpoint that was the achievement of target BP at office (<130/80mmHg) after SGLT2i treatment. From ROC curve analysis, the estimated optimal cutoff value for BMI as a marker for the endpoint was 29.For comparative analyses, we performed the cohort model of patients with BMI > 29 at baseline or those with BMI <29, that was used propensity score–matching methods with the following algorithm: 1:1 nearest neighbor match with a ±0.047 caliper and no replacement. Results: The comparison of 130 propensity-matched patients in each group were performed. The incidence of the achievement of target BP after treatment was significantly higher in patients with BMI<29 at baseline than in those with BMI > 29 (n = 44 [33.8%] and n = 27 [20.8%], respectively, p = 0.018). The mean arterial pressure after SGLT2i treatment was significantly lower in patients with BMI<29, compared with those with BMI > 29 (94.5 ± 9.4 and 98.5 ± 10.0 mmHg, respectively, p = 0.002). From the analysis of mean prevalence of incidence of the endpoint depending on the quintiles of all patients, there was a significant difference between the two groups (p = 0.017) and the OR for the endpoint was 0.538 (95%CI,0.332, 0.873, p = 0.012, Mantel-Haenszel method) in patients with BMI<29. Conclusions: The BMI influenced the achievement ratio of target BP in Japanese T2DM patients with CKD. Further study should be performed to clarify the relation between obesity and BP lowering effects by SGLT2i treatment.