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Abstract: FR-OR071

Circadian BP Rhythm as a Possible Key Target of SGLT2 Inhibitors for DKD: Yokohama Add-on Inhibitory Efficacy of Dapagliflozin on Albuminuria in Japanese T2DM Patients (Y-AIDA) Study

Session Information

Category: Hypertension and CVD

  • 1403 Hypertension and CVD: Mechanisms

Authors

  • Tamura, Kouichi, Yokohama City University Graduate School of Medicine, Yokohama, Japan
  • Kinguchi, Sho, Yokohama City University Graduate School of Medicine, Yokohama, Japan
  • Wakui, Hiromichi, Yokohama City University Graduate School of Medicine, Yokohama, Japan
  • Ito, Yuzuru, Yokohama City University Medical Center, Yokohama, Japan
  • Azushima, Kengo, Duke-NUS Medical School, Singapore, Singapore
  • Osada, Uru Nezu, Saiseikai Yokohamashi Nanbu Hospital, Yokohama, Japan
  • Iwamoto, Tamio, Saiseikai Yokohama Nanbu Hospital, Yokohama, Japan
  • Misumi, Toshihiro, Yokohama City University Graduate School of Medicine, Yokohama, Japan
  • Yamada, Takayuki, Yokohama City University Graduate School of Medicine, Yokohama, Japan
  • Orime, Kazuki, Yokohama City University Graduate School of Medicine, Yokohama, Japan
  • Kobayashi, Ryu, Yokohama City University Graduate School of Medicine, Yokohama, Japan
  • Ohki, Kohji, Yokohama City University Graduate School of Medicine, Yokohama, Japan
  • Haruhara, Kotaro, The Jikei University School of Medcine, South Yarra, Victoria, Australia
  • Kondo, Yoshinobu, Yokohama City University Medical Center, Yokohama, Japan
  • Yamakawa, Tadashi, Yokohama City Unieversity Medical Center, Yokohama, Japan
  • Yasuda, Gen, Yokohamahigasigutijin Clinic, Yokohama, Japan
  • Yamanaka, Takeharu, Yokohama City Univ., Yokohama, Japan
  • Terauchi, Yasuo, Yokohama City University Graduate School of Medicine, Yokohama, Japan
Background

In treating T2DM, it is important to appropriately manage glucose and lipid metabolism, body weight and BP and to suppress the development and progression of diabetic complications to restore the quality of life to a level comparable with healthy subjects. The Y-AIDA study was designed to investigate the renal and home BP modulating effects of add-on dapagliflozin treatment in Japanese T2DM individuals with albuminuria.

Methods

This study was a prospective, multicenter, single-arm study. A total of 86 T2DM (HbA1c 7.0-10.0%) individuals with albuminuria (UACR ≧ 30 mg/gCr) were enrolled, and 85 participants were administered with add-on dapagliflozin for 24 weeks. The primary and key secondary endpoints were change from baseline in the natural logarithm of UACR over 24 weeks and change in home BP profile at week 24. This study was registered at UMIN Clinical Trials Registry (UMIN000018930; http://www.umin.ac.jp/ctr/index-j.htm). All participants provided written informed consent prior to initiation of the study.

Results

Baseline median UACR was 181.5 mg/gCr (interquartile range 47.85, 638.0). Baseline morning, evening and nocturnal home systolic/diastolic BP were 137.6/82.7 mmHg, 136.1/79.3 mmHg, and 125.4/74.1 mmHg, respectively. After 24 weeks, the logarithm of UACR decreased by 0.37±0.73 (P<0.001). In addition, changes in morning, evening and nocturnal home BP from baseline were morning systolic/diastolic BP -8.32±11.42/-4.18±5.91 mmHg (both P<0.001), evening systolic/diastolic BP -9.57±12.08/-4.48±6.45 mmHg (both P<0.001) and nocturnal systolic/diastolic BP -2.38±7.82/-1.17±5.39 mmHg (P=0.0079 for systolic BP, P=0.0415 for diastolic BP). Furthermore, the reduction in UACR after 24 weeks significantly correlated with the improvement of home BP profile, but not with changes in other variables including office BP.

Conclusion

In Japanese T2DM individuals with albuminuric DKD, dapagliflozin not only lowered albuminuria but also improved home BP profile, suggesting that circadian BP rhythm estimated by out-of-office home BP monitoring as a possible key target of SGLT2 inhibitors for DKD.