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Wilson JR, Garner EM, Mashayekhi M, Hubers SA, Ramirez Bustamante CE, Kerman SJ, Nian H, Shibao CA, Brown NJ. DPP4 (Dipeptidyl Peptidase-4) Inhibition Increases Catecholamines Without Increasing Blood Pressure During Sustained ACE (Angiotensin-Converting Enzyme) Inhibitor Treatment. Hypertension 2022; 79:827-835. [PMID: 35045722 PMCID: PMC8917054 DOI: 10.1161/hypertensionaha.121.18348] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND DPP4 (dipeptidyl peptidase-4) inhibitors comprise a class of oral diabetes medication that have the potential for off-target cardiovascular effects. We previously showed that DPP4 inhibition attenuates the hypotensive effect of acute ACE (angiotensin-converting enzyme) inhibition and increases norepinephrine. Here, we investigated the effects of DPP4 during sustained ACE inhibition compared with during therapy with an ARB (angiotensin receptor blocker) or calcium channel blocker (neutral comparator) in a randomized, double-blinded crossover study. METHODS We enrolled 106 adults with type 2 diabetes and hypertension and 100 received intervention. Subjects were randomized to one of 3 blood pressure arms: ramipril, valsartan, or amlodipine for a total of 15 weeks and received 3 one-week crossover therapies in random order: placebo + placebo, sitagliptin + placebo, and sitagliptin + aprepitant separated by 4-week washout. RESULTS We found that DPP4 inhibition increased norepinephrine during ramipril but did not increase blood pressure. Aprepitant, a NK1 (substance P) receptor blocker, lowered standing heart rate during renin-angiotensin-aldosterone system blockade with ramipril or valsartan. CONCLUSIONS Increased catecholamines during concurrent ACE and DPP4 inhibition may contribute to cardiovascular complications in patients predisposed to heart failure.
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Affiliation(s)
- Jessica R Wilson
- Division of Clinical Pharmacology, Vanderbilt Department of Medicine. (J.R.W., S.A.H., C.E.R.B., S.J.K., N.J.B.).,Division of Endocrinology, Diabetes, and Metabolism, Vanderbilt Department of Medicine. (J.R.W., E.M.G., M.M., C.A.S.).,Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Mayo Clinic Florida (J.R.W.)
| | - Erica M Garner
- Division of Endocrinology, Diabetes, and Metabolism, Vanderbilt Department of Medicine. (J.R.W., E.M.G., M.M., C.A.S.)
| | - Mona Mashayekhi
- Division of Endocrinology, Diabetes, and Metabolism, Vanderbilt Department of Medicine. (J.R.W., E.M.G., M.M., C.A.S.)
| | - Scott A Hubers
- Division of Clinical Pharmacology, Vanderbilt Department of Medicine. (J.R.W., S.A.H., C.E.R.B., S.J.K., N.J.B.).,Division of Cardiology, Department of Medicine, University of Minnesota (S.A.H.)
| | - Claudia E Ramirez Bustamante
- Division of Clinical Pharmacology, Vanderbilt Department of Medicine. (J.R.W., S.A.H., C.E.R.B., S.J.K., N.J.B.).,Department of Medicine, Baylor College of Medicine (C.E.R.B.)
| | - Scott Jafarian Kerman
- Division of Clinical Pharmacology, Vanderbilt Department of Medicine. (J.R.W., S.A.H., C.E.R.B., S.J.K., N.J.B.)
| | - Hui Nian
- Department of Biostatistics, Vanderbilt University (H.N.)
| | - Cyndya A Shibao
- Division of Endocrinology, Diabetes, and Metabolism, Vanderbilt Department of Medicine. (J.R.W., E.M.G., M.M., C.A.S.)
| | - Nancy J Brown
- Division of Clinical Pharmacology, Vanderbilt Department of Medicine. (J.R.W., S.A.H., C.E.R.B., S.J.K., N.J.B.).,Department of Medicine, Yale School of Medicine (N.J.B.)
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Hemodynamic effects of the dipeptidyl peptidase-4 inhibitor linagliptin with renin-angiotensin system inhibitors in type 2 diabetic patients with albuminuria. J Hypertens 2020; 37:1294-1300. [PMID: 30540657 PMCID: PMC6513080 DOI: 10.1097/hjh.0000000000002032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Objective: Concomitant treatment with angiotensin-converting enzyme (ACE) inhibitors and dipeptidyl peptidase-4 (DPP-4) inhibitors is increasingly common. Pharmacological studies have suggested a potential adverse drug interaction between ACE inhibitors and DPP-4 inhibitors resulting in unfavorable hemodynamic changes; very few studies have examined such an interaction between angiotensin II receptor blockers (ARBs) and DPP-4 inhibitors. We investigated blood pressure (BP) and heart rate (HR) during treatment with the DPP-4 inhibitor linagliptin in individuals receiving either ACE inhibitors or ARBs in the MARLINA-T2D trial. Methods: In this study, 360 individuals with type 2 diabetes and albuminuria receiving unchanged doses of ACE inhibitors or ARBs were randomized to linagliptin or placebo. Twenty-four-hour ambulatory BP monitoring, an exploratory endpoint, was conducted at baseline and after 24 weeks. Results: Ambulatory BP monitoring data were available for 208 individuals (linagliptin: n = 111; placebo: n = 97). Baseline mean ± SD 24-h SBP and DBP were 132.5 ± 12.4 mmHg and 75.9 ± 9.4 mmHg, respectively; mean 24-h HR was 76.3 ± 10.1 bpm. At week 24, no overall effect of the DPP-4 inhibitor versus placebo was seen on mean 24-h SBP, DBP, or HR. Furthermore, in the subgroups receiving either an ACE inhibitor or an ARB, no effect on these hemodynamic parameters was seen as a result of concomitant DPP-4 inhibitor treatment. Conclusion: Adding linagliptin to treatment with ACE inhibitors or ARBs was not associated with any hemodynamic changes, supporting their concomitant use in individuals with type 2 diabetes and albuminuria.
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Lumbers ER, Delforce SJ, Pringle KG, Smith GR. The Lung, the Heart, the Novel Coronavirus, and the Renin-Angiotensin System; The Need for Clinical Trials. Front Med (Lausanne) 2020; 7:248. [PMID: 32574336 PMCID: PMC7256451 DOI: 10.3389/fmed.2020.00248] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/11/2020] [Indexed: 01/08/2023] Open
Abstract
Angiotensin-converting enzyme 2 (ACE2) is the receptor for COVID-19 (SARs-CoV-2). ACE2 protects the lung and heart from acute respiratory distress syndrome (ARDS) and acute myocarditis and arrhythmias, because it breaks down Angiotensin II, which has inflammatory effects in the lung and heart as well as in the kidney. When SARS-CoV-2 binds to ACE2, it suppresses it, so this protective action of ACE2 is lost. Death from COVID-19 is due to ARDS and also heart failure and acute cardiac injury. Drugs that prevent the inflammatory actions of Angiotensin II (i.e., Angiotensin receptor blockers, ARBs) prevent acute lung injury caused by SARS-CoV. Clinical trials are underway to test the risks and benefits of ARBs and angiotensin-converting enzyme inhibitors (ACEIs) in COVID-19 patients requiring hospitalization. Other potential treatments are also discussed.
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Affiliation(s)
- Eugenie R. Lumbers
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW, Australia
- Priority Research Centre for Reproductive Science, University of Newcastle, Callaghan, NSW, Australia
- Pregnancy and Reproduction Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Sarah J. Delforce
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW, Australia
- Priority Research Centre for Reproductive Science, University of Newcastle, Callaghan, NSW, Australia
- Pregnancy and Reproduction Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Kirsty G. Pringle
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW, Australia
- Priority Research Centre for Reproductive Science, University of Newcastle, Callaghan, NSW, Australia
- Pregnancy and Reproduction Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Gary R. Smith
- VP System Practice, International Society for the System Sciences, Pontypool, United Kingdom
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