Article Impact Level: HIGH Data Quality: STRONG Summary of Circulation, 146(6), 450–462. https://doi.org/10.1161/CIRCULATIONAHA.122.059150 Dr. Yuliya Lytvyn et al
Points
- The main goal of the crossover trial was to find out the cardio-renal effects of sodium-glucose co-transporter II inhibition (Empagliflozin) with a combination of angiotensin-converting enzyme inhibition (Ramipril) in patients of type-I diabetes who have a potential of renal hyper-filtration.
- The result indicates the positive effects of empagliflozin when added with ramipril, as it shows an expected dip in glomerular filtration rate, total peripheral resistance, reduction in blood pressure, as well as suppression of oxidative stress markers.
- These findings are similar to the protecting physiologic profile categorized through the reduction of intra-glomerular pressure as well as related cardio-renal risk when empagliflozin was added to conservative therapy.
Summary
A double-blind, placebo-controlled crossover study was conducted to check the effects of empagliflozin combined with ramipril treatment on diabetic patients of type-I who have potential renal hyper-filtration. For this purpose, 30 patients were selected and kept under observation for 19 weeks over 6 treatment phases. The first phase was baseline measurement without any treatment; in the second phase, ramipril treatment was provided for 4 weeks; in the third phase, ramipril with a combination of empagliflozin was provided for 4 weeks. The fourth phase was a wash-out time of 4 weeks; in the fifth phase combination of ramipril with placebo treatment was provided for 4 weeks, and the last phase was a follow-up of 1 week.
In the first endpoint, the glomerular filtration rate was measured after the combined treatment of ramipril-empagliflozin compared to ramipril-placebo treatment. At the completion of this study following results were evaluated under clamped euglycemia: para-aminohippurate and inulin clearances, ambulatory blood pressure, tubular sodium handling, heart rate variability, arterial stiffness, plasma and urine biochemistry, monitoring of cardiac output, oxidative stress, as well as indicators of the renin-angiotensin-aldosterone system.
Combining empagliflozin with ramipril resulted in an expected dip in glomerular filtration rate, total peripheral resistance, additive declines in blood pressure, and suppression of oxidative stress markers. These findings are similar to the protecting physiologic profile categorized through the reduction of intra-glomerular pressure as well as related cardio-renal risk when empagliflozin was added to conservative therapy.
Link to the article: https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.122.059150
References Lytvyn, Y., Kimura, K., Peter, N., Lai, V., Tse, J., Cham, L., Perkins, B. A., Soleymanlou, N., & Cherney, D. Z. I. (2022). Renal and vascular effects of combined sglt2 and angiotensin-converting enzyme inhibition. Circulation, 146(6), 450–462. https://doi.org/10.1161/CIRCULATIONAHA.122.059150
