Combination of empagliflozin and linagliptin improves blood pressure and vascular function in type 2 diabetes

Abstract Aims Preserved vascular function represents a key prognostic factor in type 2 diabetes mellitus (T2DM), but data on vascular parameters in this patient cohort are scarce. Patients with T2DM often need more than one drug to achieve optimal glucose control. The aim of this study was to analyse the efficacy of two combination therapies on vascular function in subjects with T2DM. Methods and results This prospective, randomized study included 97 subjects with T2DM. Subjects were randomized to either the combination therapy empagliflozin (E) 10 mg with linagliptin (L) 5 mg once daily or metformin (M) 850 or 1000 mg twice daily with insulin glargine (I) once daily. At baseline and after 12 weeks, subjects had peripheral office and 24-h ambulatory blood pressure (BP) measurement and underwent vascular assessment by pulse wave analysis under office and ambulatory conditions. Office, 24-h ambulatory and central BP as well as pulse pressure (PP) decreased after 12 weeks of treatment with E + L, whereas no change was observed in M + I. There were greater decreases in 24-h ambulatory peripheral systolic (between-group difference: −5.2 ± 1.5 mmHg, P = 0.004), diastolic BP (−1.9 ± 1.0 mmHg, P = 0.036), and PP (−3.3 ± 1.0 mmHg, P = 0.007) in E + L than M + I. Central office systolic BP (−5.56 ± 1.9 mmHg, P = 0.009), forward pressure height of the pulse wave (−2.0 ± 0.9 mmHg, P = 0.028), 24-h ambulatory central systolic (−3.6 ± 1.4 mmHg, P = 0.045), diastolic BP (−1.95 ± 1.1 mmHg, P = 0.041), and 24-h pulse wave velocity (−0.14 ± 0.05m/s, P = 0.043) were reduced to a greater extent with E + L. Conclusion Beyond the effects on glycaemic control, the combination therapy of E + L significantly improved central BP and vascular function compared with the classic combination of M + I. ClinicalTrials.gov NCT02752113.