Influence of combination therapy with SGLT2 inhibitors and GLP-1 receptor agonists on the management of blood pressure in Japanese patients with diabetes.

Combination therapy with a sodium-glucose cotransporter 2 inhibitor (SGLT2i) and glucagon-like peptide-1 receptor agonist (GLP-1RA) is increasingly used to prevent cardiovascular events. Our previous study demonstrated the renal benefits of this combination therapy. Both drug classes exert pleiotropic effects on metabolic factors, such as obesity and hypertension; however, the impact of this combination therapy on blood pressure (BP) has not been fully evaluated. This post hoc analysis aimed to assess the effects of SGLT2i-GLP-1RA combination therapy on BP control in patients with type 2 diabetes (T2D). Among the 643 T2D patients enrolled in the RECAP study, 431 with baseline hypertension were analyzed (GLP-1RA-preceding group, n = 207; SGLT2i-preceding group, n = 224). The achievement rate of the target office BP ( < 130/80 mmHg) after the initiation of combination therapy was evaluated using multiple imputations. Changes in office and home BP were analyzed using generalized linear mixed models. The influence of preceding treatment was assessed using propensity score-based inverse probability weighting (PS-IPW). The achievement rate of the target BP increased from 25.4% after treatment to 33.3% after combination therapy (p = 0.003). Office BP decreased from 141.8/82.4 mmHg at baseline to 135.2/78.5 mmHg after treatment addition and 131.7/79.4 mmHg after combination therapy (all p < 0.001). The home systolic BP also significantly decreased (p = 0.03). PS-IPW analysis showed no significant differences in BP outcomes or target achievement rates according to the preceding treatment. Collectively, SGLT2i-GLP-1RA combination therapy significantly improved BP control, independent of the order in which the agents were initiated.