ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on X

Kidney Week

Abstract: SA-PO507

Heart Failure (HF) in the SGLT2 Inhibitor (SGLT2i) and GLP1 Receptor Agonist (GLP1-RA) Era: Does Hypertension (HTN) Matter?

Session Information

Category: Hypertension and CVD

  • 1602 Hypertension and CVD: Clinical

Authors

  • Hartsell, Sydney Elizabeth, VA Salt Lake City Health Care System, Salt Lake City, Utah, United States
  • Sarwal, Amara, VA Salt Lake City Health Care System, Salt Lake City, Utah, United States
  • Shen, Jincheng, VA Salt Lake City Health Care System, Salt Lake City, Utah, United States
  • Wei, Guo, VA Salt Lake City Health Care System, Salt Lake City, Utah, United States
  • Nevers, Mckenna R., VA Salt Lake City Health Care System, Salt Lake City, Utah, United States
  • Adams, Brad, VA Salt Lake City Health Care System, Salt Lake City, Utah, United States
  • Singh, Ravinder, VA Salt Lake City Health Care System, Salt Lake City, Utah, United States
  • Boucher, Robert E., VA Salt Lake City Health Care System, Salt Lake City, Utah, United States
  • Greene, Tom, VA Salt Lake City Health Care System, Salt Lake City, Utah, United States
  • Beddhu, Srinivasan, VA Salt Lake City Health Care System, Salt Lake City, Utah, United States
Background

Whether uncontrolled HTN modifies the potential protective effects of SGLT2-I and GLP1-RA on HF is unknown.

Methods

We conducted an active comparator, new user design study in a national cohort of veterans (N = 129,186) with type 2 diabetes (T2D) on metformin without HF at baseline and initiated on an SGLT2i, GLP1-RA or insulin glargine (IG) for the first time between 1/1/18 and 12/31/21 and followed until 3/31/23. In Cox models, we examined whether the associations of SBP categories with HF risk modified by the drug class.

Results

13.1% were initiated on GLP1RA, 38.9% on IG and 47.9% on SGLT2i. There were 8,850 HF events over 355,990 person-years. Within each of the drug classes, those with SBP 110 to 130 mmHg had the lowest and > 150 mmHg the highest incidence of HF (Fig). In a multivariable Cox model adjusted for SBP levels, demographics, comorbidity, CKD stages and other variables, compared to GLP1RA, IG had higher risk of HF but SGLT2i had similar risk (Table). In the same model, there was a graded association of SBP levels with the risk of HF (Table). The product interaction term of drug classes and SBP categories was not significant (p = 0.65).

Conclusion

HTN remains a significant risk factor for HF in veterans with T2D initated on SGLT2i or GLP1RA.

HF risk by Drug Class and SBP groups
PredictorHR (95% CI)
Drugs
GLP1Reference
Insulin Glargine1.19 (1.11, 1.27)
SGLT2i0.93 (0.87, 0.99)
SBP Groups
<1101.20 (1.10, 1.31)
110 to <130Reference
130 to <1401.03 (0.97, 1.09)
140 to <1501.21 (1.13, 1.29)
≥1501.42 (1.33, 1.52)

Product interaction term = 0.65