Abstract: TH-PO0337
Effect of SGLT2 Inhibitors Combined with Mineralocorticoid Receptor Antagonists in Patients with Primary Aldosteronism and Diabetes: A Real-World Study
Session Information
- Hypertension and CVD: Clinical - 1
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1602 Hypertension and CVD: Clinical
Authors
- Lai, Chun-Fu, National Taiwan University Hospital, Taipei City, Taiwan
- Chang, Li-Yang, National Taiwan University College of Medicine, Taipei City, Taiwan
- Huang, Chieh, National Taiwan University College of Medicine, Taipei City, Taiwan
- Wu, Vincent, National Taiwan University Hospital, Taipei City, Taiwan
Group or Team Name
- Taiwan Primary Aldosteronism Investigators (TAIPAI) Study Group.
Background
Patients with primary aldosteronism (PA) are at increased risk for cardiovascular and renal complications. Sodium-glucose cotransporter-2 (SGLT2) inhibitors have shown protective effects in individuals at high risk for cardiorenal events and may provide similar benefits to PA patients. This study evaluates the clinical outcomes of adding SGLT2 inhibitors to mineralocorticoid receptor antagonists (MRA) in patients with PA and diabetes.
Methods
We conducted a retrospective cohort study using data from the TriNetX database between February 1, 2014, and February 1, 2024. We included patients with PA and type 2 diabetes who received MRAs within 3 months before and after PA diagnosis and did not undergo adrenalectomy. Participants were grouped by SGLT2 inhibitors use within 3 months around PA diagnosis. The primary outcome was 1-year all-cause mortality, while secondary outcomes included major adverse cardiovascular events (MACE) and major adverse kidney events (MAKE). After 1:1 propensity score matching between groups, adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards models.
Results
Among the 8,692 enrolled patients (mean (SD) age, 64.23 [11.99] years; 47.5% men and 52.5% women), 1,592 individuals (18.3%) were identified as SGLT2 inhibitor users. After propensity score matching, 1,575 individuals in the SGLT2 inhibitor group exhibited a reduced mortality compared to 1,575 in the non-user group (aHR, 0.72, [95% CI, 0.57-0.92]). Furthermore, receiving SGLT2 inhibitors was associated with a lower risk of MACE (aHR, 0.59, [95% CI, 0.45-0.77]) and MAKE (aHR, 0.77, [95% CI, 0.61-0.96]) compared with non-users. (Figure) Of note, the risk reduction associated with SGLT2 inhibitors remained consistent across various subgroups, including older patients, those with advanced kidney disease, and individuals who had been on angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers.
Conclusion
Our findings suggest that incorporating SGLT2 inhibitors into PA treatment may provide additional cardiorenal protection for this high-risk population.
Kaplan-Meier curves of outcomes.
Funding
- Government Support – Non-U.S.