From the Guidelines
Farxiga (dapagliflozin) can cause modest reductions in blood pressure as a secondary effect, typically lowering systolic blood pressure by 3-5 mmHg and diastolic blood pressure by 1-2 mmHg in most patients, as supported by the most recent evidence from the DAPA-HF trial 1.
Mechanism of Action
The blood pressure reduction effect of Farxiga occurs because it works as an SGLT2 inhibitor, causing increased glucose excretion in urine along with sodium, which leads to mild diuretic effects and reduced blood volume. This mechanism is consistent with the findings of the EMPA-REG OUTCOME, CANVAS, DECLARE-TIMI 58, and CREDENCE trials, which demonstrated robust benefits of SGLT2 inhibitors in the prevention of heart failure hospitalizations 1.
Clinical Implications
The blood pressure lowering effect of Farxiga usually begins within the first few weeks of treatment and persists with continued use. Patients should be aware that this blood pressure reduction, while generally beneficial, can occasionally cause symptoms of low blood pressure such as dizziness or lightheadedness, particularly when starting the medication or in those taking other blood pressure medications. Anyone experiencing severe dizziness, fainting, or significant drops in blood pressure while taking Farxiga should contact their healthcare provider, as dosage adjustments of Farxiga or other medications may be necessary.
Key Findings
- The DAPA-HF trial demonstrated a lower risk of worsening heart failure and cardiovascular death in patients with New York Heart Association class II, III, or IV heart failure and an ejection fraction of 40% or less treated with dapagliflozin compared with placebo 1.
- The EMPEROR-Reduced trial showed a 21% reduction in the primary composite outcome of cardiovascular death or hospitalization for worsening heart failure in patients with heart failure and an ejection fraction of 40% or less treated with empagliflozin compared with placebo 1.
- The DELIVER trial demonstrated an 18% reduction in the primary outcome of a composite of worsening heart failure or cardiovascular death in patients with heart failure and an ejection fraction >40% treated with dapagliflozin compared with placebo 1.
Recommendations
Based on the most recent and highest-quality evidence, Farxiga (dapagliflozin) is recommended for patients with type 2 diabetes and established heart failure with reduced ejection fraction (HFrEF) to reduce the risk of worsening heart failure and cardiovascular death, as well as for patients with heart failure and preserved ejection fraction (HFpEF) 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Effects of Farxiga (Dapagliflozin) on Blood Pressure
- Dapagliflozin has been shown to reduce blood pressure in patients with type 2 diabetes, as evidenced by a study published in the journal Drugs 2.
- The reduction in blood pressure is attributed to the drug's mechanism of action, which involves the inhibition of sodium-glucose cotransporter-2, leading to increased glucosuria and natriuresis 3.
- A study published in the journal Circulation found that dapagliflozin reduced systolic blood pressure by 2.4 mmHg compared to placebo at 48 months 4.
- The blood pressure-lowering effect of dapagliflozin was consistent across different baseline blood pressure categories, with no evidence of modification of treatment effect 4.
Clinical Implications
- The reduction in blood pressure with dapagliflozin may contribute to its cardioprotective effects, including reduced risk of hospitalization for heart failure and cardiovascular death 5, 6.
- The drug's ability to lower blood pressure without increasing the risk of hypoglycemia makes it a valuable treatment option for patients with type 2 diabetes 2, 3.
- However, dapagliflozin may increase the risk of genital infections and diabetic ketoacidosis, highlighting the need for careful patient selection and monitoring 6.