An evaluation of empagliflozin and it’s applicability to hypertension as a therapeutic option

ABSTRACT

Introduction

Sodium-glucose cotransporter 2 (SGLT2) inhibitors such as Empagliflozin are novel antihyperglycemic drugs approved for the treatment of type 2 diabetes (T2D). In addition to its glucose-lowering effects, Empagliflozin promotes weight loss, blood pressure reduction, and other beneficial metabolic benefits.

Areas covered

This review outlines the pharmacokinetics, pharmacodynamics, safety, and tolerability of Empagliflozin and discusses its role in diabetes-associated hypertension.

Expert opinion

Empagliflozin was the first in class to not only demonstrate safety of SGLT2 inhibition but also cardio- and reno-protective effects in an adequately powered cardiovascular outcome trial. The EMPA-REG study showed significant reductions in mortality from cardiovascular causes, hospitalization for heart failure, and progression of diabetic kidney disease. These benefits cannot be attributed to glycemic control alone, suggesting the involvement of other SGLT2 inhibition-mediated mechanisms. Recent data suggests the potential utility of SGLT2 inhibition in other conditions including type 1 diabetes (T1D) and non-diabetic heart failure patients with clinical trials currently being conducted. In concert with ongoing pre-clinical investigations to unravel the mechanisms contributing to cardiorenal protection, the full therapeutic potential of SGLT2 inhibition will become apparent over the next few years and promises to be one of the major success stories in clinical medicine.

Abbreviations

T1D: type 1 diabetes; T2D: type 2 diabetes; SGLT2: sodium-glucose cotransporter 2; CVD: cardiovascular disease; SBP: systolic blood pressure; DBP: diastolic blood pressure; SNS: sympathetic nervous system; BP: blood pressure; CV: cardiovascular; ZDF: Zucker diabetic fatty; CKD: chronic kidney disease; FDA: Food and Drug Administration

KEYWORDS:

• SGLT2
• SGLT2 inhibitors
• empagliflozin
• diabetes
• hypertension
• cardiovascular disease

Article highlights

• SGLT-2 inhibition is a novel and effective approach to improve glucose control in patients with type 2 diabetes.

• Large randomized controlled clinical trials have demonstrated that SGLT-2 inhibition is associated with reduced mortality from cardiovascular causes.

• Diuretic, blood pressure lowering and other beneficial effects contribute to cardiovascular and renal protection elicited by SGLT-2 inhibitors.

• Ongoing studies will demonstrate the full clinical potential of SGLT-2 inihibitors, specifically in the context of non-diabetic heart failure.

Declaration of interest

M Schlaich has received research grant support from Boehringer Ingelheim. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer Disclosures

A reviewer has received consultancies, speaker’s fees, and travel grants in the past from Boehringer Ingelheim who hold the exclusive rights on empagliflozin. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Box 1. Drug Summary Box

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Additional information

Funding

This manuscript has not been funded.