Blood Pressure Effects of Canagliflozin and Clinical Outcomes in Type 2 Diabetes and Chronic Kidney Disease

Background: People with type 2 diabetes and chronic kidney disease experience a high burden of hypertension, but the magnitude consistency blood pressure (BP) lowering canagliflozin in this population are uncertain. Whether effects on cardiovascular outcomes vary by baseline BP or BP-lowering therapy is also unknown. Methods: The CREDENCE trial (Canagliflozin Renal Events Diabetes Established Nephropathy Clinical Evaluation) randomized people to placebo. In post hoc analysis, we investigated effect systolic across subgroups defined BP, number drug classes, history apparent treatment-resistant hypertension (BP ?130/80 mm Hg while receiving ?3 classes drugs, including diuretic). We assessed whether clinical differed these subgroups. Results: included 4401 participants, whom 3361 (76.4%) had ?130 Hg, 1371 (31.2%) resistant hypertension. By week 3, reduced 3.50 (95% CI, –4.27 –2.72), an maintained over duration trial, similar reductions (all P interaction ?0.05). Canagliflozin need for initiation additional agents during (hazard ratio, 0.68 [95% 0.61–0.75]). failure, doubling serum creatinine, death caused 0.70 0.59–0.82]) was consistent ?0.35), as were other key kidney, cardiovascular, safety outcomes. Conclusions: disease, lowers all BP-defined reduces agents. These findings support use end-organ protection adjunct disease. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02065791.