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Pretreatment body mass index affects achievement of target blood pressure with sodium-glucose cotransporter 2 inhibitors in patients with type 2 diabetes mellitus and chronic kidney disease

Hypertension Research volume 47, pages 628–638 (2024)Cite this article

Abstract

Sodium-glucose cotransporter 2 inhibitor (SGLT2-I) shows excellent antihypertensive effects in addition to its hypoglycemic effects. However, whether body mass index (BMI) affects the antihypertensive effect of SGLT2-I remains unknown. We investigated the impact of baseline BMI on the achievement of target blood pressure (BP) with SGLT2-I treatment in Japanese patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). We retrospectively evaluated 447 Japanese patients with T2DM and CKD treated with SGLT2-I for at least 1 year. The primary outcome was achieving the target BP (<130/80 mmHg) after SGLT2-I treatment. Patients were divided into two groups according to a baseline BMI of 29.1 determined by receiver operating characteristic analysis and analyzed in a cohort model with propensity score matching. In each group, 130 patients were compared by propensity score matching. The target BP achievement rate was significantly higher in the BMI < 29.1 group than in the BMI ≥ 29.1 group (34% and 21%, respectively, p = 0.03). The odds ratio for achieving the target BP in the BMI ≥ 29.1 group was 0.50 (95% confidence interval, 0.28–0.90, p = 0.02). The BMI < 29.1 group had significantly lower systolic and diastolic BPs after SGLT2-I treatment than the BMI ≥ 29.1 group. Only the BMI < 29.1 group was showed a significant decrease in the logarithmic albumin-to-creatinine ratio from baseline after SGLT2-I treatment. In patients with T2DM and CKD, baseline BMI was associated with the antihypertensive effects of SGLT2-I. Patients in the lower baseline BMI group were more likely to achieve the target BP after SGLT2-I treatment.

Pretreatment BMI affects the antihypertensice effect of SGLT2 inhibirors in patients with T2DM and CKD.

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Data availability

Data are available from the Kanagawa Physicians Association Data Access/Ethics Committee for investigators, bound by confidentiality agreements. Contact details: Kazuo Kobayashi MD/PhD, Kanagawa Physicians Association, 3-1Fujimicho naka-ku, Yokohama City, Kanagawa Prefecture, Japan E-mail: k-taishi@xc4.so-net.ne.jp.

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Acknowledgements

We are grateful to all participants of this study and acknowledge the support of Kouta Aoyama, Mitsuo Obana, Shinichi Umezawa, Moritugu Kimura, Yoshiro Hamada, Hiroshi Takeda, Hisakazu Degawa, Hareaki Yamamoto, Hideo Machimura, Kohsuke Minamisawa, Noriyuki Asaba, Yoshiro Suzuki, Satoshi Suzuki, Sanae Takeichi, Keiichi Sekino, Tetsuo Takuma, Noriko Kanaoka, and Nobumichi Saito who contributed considerably to data collection. We also would like to thank Editage (www.editage.com) for English language editing.

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Authors and Affiliations

  1. Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan

    Shunichiro Tsukamoto, Kazuo Kobayashi, Tomohiko Kanaoka, Hiromichi Wakui & Kouichi Tamura

  2. Committee of Hypertension and Kidney disease, Kanagawa Physicians Association, Yokohama, Japan

    Kazuo Kobayashi, Nobuo Hatori, Hiroyuki Sakai, Takayuki Furuki, Keiichi Chin, Shun Ito, Daisuke Suzuki, Tomoya Umezono, Shinichi Nakajima, Toshimasa Hishiki, Yutaka Hatori, Masahiro Hayashi, Hidetoshi Shimura, Fuyuki Minagawa, Atsuko Mokubo, Masahiro Takihata, Kazuyoshi Sato, Masaaki Miyakawa & Akira Kanamori

  3. Division of Nephrology, Endocrinology and Metabolism, Department of internal medicine, Tokai University School of Medicine, lsehara, Japan

    Masao Toyoda

  4. Division of Nephrology, Department of internal medicine, Kitasato University School of Medicine, Sagamihara, Japan

    Togo Aoyama

  5. Department of Endocrinology and Metabolism, Yokohama City University Graduate School of Medicine, Yokohama, Japan

    Yasuo Terauchi

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  1. Shunichiro Tsukamoto
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Tsukamoto, S., Kobayashi, K., Toyoda, M. et al. Pretreatment body mass index affects achievement of target blood pressure with sodium-glucose cotransporter 2 inhibitors in patients with type 2 diabetes mellitus and chronic kidney disease. Hypertens Res 47, 628–638 (2024). https://doi.org/10.1038/s41440-023-01464-y

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