SGLT2 inhibitors: not for hypertension but exceedingly useful in hypertension
Abstract
This editorial refers to ‘Empagliflozin in resistant hypertension and heart failure with preserved ejection fraction: the EMPEROR-Preserved trial’, by M. Böhm et al., https://doi.org/10.1093/eurheartj/ehae938. In the present issue of the European Heart Journal, Michael Böhm et al. present a sophisticated blood pressure (BP) analysis of the EMPEROR-PRESERVED trial suggesting that in heart failure with a preserved ejection fraction (HFpEF), moderate modifications of BP do not affect overall outcomes and treatment effects of empagliflozin.1 Hypertension is a powerful risk factor for heart failure (HF), in particular for patients with HFpEF.2 Thus, in this study, >90% of patients with HFpEF had a history of hypertension. These 5333 patients were subdivided according to their hypertension pattern into controlled, uncontrolled, and resistant. Not surprisingly, in those with resistant hypertension, the rate of primary outcome was higher than in the other two groups. However, cardiorenal effects of empagliflozin were not modified by the different hypertension phenotypes. Why should they be? There are at least four reasons why this, the authors’ hypothesis, was unlikely to come to fruition. HF is the end stage of hypertensive cardiovascular disease. However, HF emerges after hypertension has run its course and irreversibly lesioned the heart. Clearly, therefore, the pathophysiology of HF differs from the pathophysiology of hypertension. BP still may be elevated in HF but no longer be…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 5,333 participants or records.
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