P62 DAPAGLIFLOZIN PRESERVES RENAL VASODILATING CAPACITY IN HYPERTENSIVE PATIENTS WITH TYPE 2 DIABETES

Abstract

Aim: Mechanisms through which SGLT-2 inhibitors achieve cardiovascular and renal protection are still unknown. We investigated whether dapagliflozin modulates Na and water balance and systemic and renal vascular parameters like endothelial function, arterial stiffness and renal vasodilating capacity. Methods: 40 type2-diabetic hypertensive patients were studied at baseline (V0) and after four weeks (V1) of dapagliflozin 10 mg (Dapa, N = 20) or hydroclorothiazide 12,5 mg (HCT,N = 20), collecting blood and urinary samples for routine analyses, plasma renin activity, aldosterone, cathecolamines and 24 hour-urinary electrolytes. Flow-mediated dilation of the brachial artery (FMD), baseline (RI) and dynamic renal resistive index (DRIN), carotid-femoral pulse-wave velocity (PWV) and Augmentation Index (AIx) were also measured. Results: Both Dapa and HCT marginally lowered systolic and diastolic BP values and did not change blood fasting glucose. Serum magnesium concentration significantly rose in Dapa group (from 1.88 ± 0.27 to 2.01 ± 0.22 mg/dl, p = 0.02 for time*treatment interaction), while magnesiuria was unchanged. 24h diuresis and glycosuria and osmolar clearance increased in Dapa (p < 0.001), with no changes in sodiuria and creatinine clearance. Dapa induced also a rise in aldosterone (p = 0.02). Nor DAPA neither HCT modified FMD, AIx and PWV. Interestingly, in Dapa group DRIN remained unmodified, while tended to increase in HCT group (p = 0.05). Conclusions: 4-week Dapa treatment did not significantly influence BP, glucose and systemic indices of vascular function. However, in comparison to HCT, renal vasodilating capacity was preserved after Dapa, indicating a selective effect on renal vascular function, which may act asnephroprotective mechanism. Furthermore, the increase in serum magnesium might contribute to cardiovascular protection.