Impact of empagliflozin on blood pressure in dipper and non-dipper patients with type 2 diabetes mellitus and hypertension

In the EMPA-REG BP trial, empagliflozin significantly reduced systolic and diastolic blood pressure (SBP and DBP) compared with placebo at week 12 in patients with type 2 diabetes mellitus (T2DM) and hypertension. In a post-hoc analysis, we assessed the effect of empagliflozin on SBP and DBP using 24-hour ambulatory BP monitoring in patients categorized as dippers (sleep-time mean SBP ≤ 90% of awake-time mean; n = 417) or non-dippers (sleep-time mean SBP > 90% of awake-time mean; n = 350). In dippers, adjusted mean (SE) changes from baseline in mean 24-hour SBP (mm Hg) at week 12 were −0.2 (0.7) with placebo vs −3.8 (0.6) and −3.9 (0.7) with empagliflozin 10 and 25 mg, respectively (both P <.001 vs placebo). In non-dippers, these changes were 1.0 (0.7) with placebo vs −1.6 (0.7) with empagliflozin 10 mg (P =.013 vs placebo) and −3.8 (0.7) with empagliflozin 25 mg (P <.001 vs placebo). In both dippers and non-dippers, SBP and DBP patterns over 24 hours were maintained. There were no clinically relevant changes in heart rate with empagliflozin. In conclusion, empagliflozin significantly reduced mean 24-hour SBP compared with placebo in dippers and non-dippers.