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Blood Pressure and Dapagliflozin in Heart Failure With Mildly Reduced or Preserved Ejection Fraction: DELIVER

Senthil Selvaraj1, Muthiah Vaduganathan2, Brian L Claggett2

  • 1Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA; Duke Molecular Physiology Institute, Durham, North Carolina, USA; Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.

JACC. Heart Failure
|January 4, 2023
PubMed

Insights

Sodium-glucose cotransporter 2 (SGLT2) inhibitors like dapagliflozin modestly lower systolic blood pressure (SBP) in heart failure with preserved ejection fraction (HFpEF). Dapagliflozin

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Optimizing systolic blood pressure (SBP) in heart failure with preserved ejection fraction (HFpEF) has limited evidence despite a Class I recommendation.
  • Sodium-glucose cotransporter 2 (SGLT2) inhibitors demonstrate antihypertensive effects across various cardiovascular diseases.

Purpose of the Study:

  • To investigate the relationship between SBP and the treatment effects of dapagliflozin on cardiovascular outcomes in HFpEF patients.
  • To determine if the blood pressure-lowering effects of dapagliflozin contribute to its cardiovascular benefits.

Main Methods:

  • Analysis of 6,263 participants from the DELIVER trial (Dapagliflozin Evaluation to Improve the LIVEs of Patients With PReserved Ejection Fraction Heart Failure).
  • Categorization of participants based on baseline and achieved SBP (<120, 120-129, 130-139, ≥140 mm Hg) and assessment of primary/secondary outcomes and safety events.
  • Statistical adjustment for SBP changes from baseline to 1 month to evaluate the contribution of blood pressure reduction to treatment effects.

Main Results:

  • Lower SBP (<120 mm Hg) was linked to increased HF and mortality events, while higher SBP correlated with elevated amputation and stroke risks.
  • Dapagliflozin demonstrated a modest SBP reduction of 1.8 mm Hg compared to placebo at 1 month.
  • The treatment efficacy of dapagliflozin on the primary outcome and symptom scores was consistent across all SBP categories, with no significant interaction.

Conclusions:

  • In the DELIVER trial, cardiovascular risk was elevated at both low and high SBP levels, varying by endpoint.
  • Dapagliflozin provided consistent efficacy and safety across the spectrum of baseline SBP in HFpEF patients.
  • The observed cardiovascular benefits of dapagliflozin were independent of its blood pressure-lowering effects.
Abstract

Keywords:
SGLT2blood pressuredapagliflozinheart failure hospitalizationheart failure with preserved ejection fraction

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