1. On January 1, 2025, the European project SGLT2 Hype was launched, whose objective is to transform the treatment of hypertension. The Jiménez Díaz Foundation participates in it. Can you advance what they have managed to advance these months?
This project seeks to test if a treatment that was never used before for arterial hypertension can be beneficial for the best control of it in patients in which it is not possible to control with the usual treatment. These drugs, SGLT2 inhibitors were classically used for diabetes, but have mechanisms of action that are broader. In fact, it has been shown that they have benefits in different pathologies, such as heart failure. This study will test, for the first time, if they can also help patients with arterial hypertension refractory to the usual treatment.
2. How many people are hypertensive? Is it increasing?
It is difficult to define the number of hypertensive, but it is one of the most prevalent cardiovascular risk factors. In fact, a worldwide report has recently indicated where it is indicated that the cause number one of mortality on the planet is the non -controlled arterial hypertension, both in developed and developing countries.
3. How many patients do they see that their treatment does not work or not as they would like?
There are a lot of patients who, although they take antihypertensive drugs, are not controlled. That is why clinical practice guides recommend starting with a combination of drugs. Although it is difficult to estimate what the percentage of patients who do not have controlled hypertension with medication would not be controlled, we could say that more than half of them, although they are taking medication, do not have optimal voltage levels.
4. What are your expectations about the SGLT2 inhibitor?
Our expectations are high. These drugs improve not only the elimination of glucose by the kidneys – which also lowers blood pressure directly – but can also improve the damage that blood pressure produces. Here it is not only essential to treat blood pressure levels, but also prevent arterial hypertension from damaging the target organs: brain, kidney, heart, etc. Therefore, we believe that these drugs can help control arterial hypertension and protect target organs from the effect of arterial hypertension.
5. How many deaths could be avoided with effective therapy?
It is difficult to estimate it. We estimate that the association of these drugs will have an impact of a reduction of approximately 20% of the combined adverse events, which are not only deaths, but also infarctions, stroke or heart failure.
-6. What is the average age of diagnosis of hypertension?
It is difficult to estimate. That is why it is so important that from 18 or 20 years all people control blood tension frequently to confirm that they have normal levels or, if they have them high, to start some intervention: dietary, life or pharmacological habits if necessary. What we do know is that in many cases blood pressure is not optimal from the early stages of life. From the age of 20-25 there are people who have an blood pressure that, although it does not meet the criteria that have been called arterial hypertension, it is higher than an optimal blood pressure would be considered.
7. On the other hand, it coordinates the Dapa Tavi study that has shown that a drug to treat diabetes improves the prognosis of patients undergoing cardiac valvular intervention. In what percentage?
In the clinical trial we have tested the same drugs – the Dapagliflozine, which is a SGLT2 inhibitor – and what we have found is that patients undergoing valvular intervention, but had a pressure overload due to aortic stenosis for a long time, when this drug was associated, they had a reduction of about 30% of the risk of death or admission. Cardiac
8. This has been after a year of tracking. Do they trust that the results are even more promising at 5 years?
Indeed, we think the benefit will be maintained over time. That is, these patients, if they receive these drugs, will achieve the reduction of these events not only in the first year. What happens is that, after the publication of the clinical trial, the vast majority of these patients – already in the real world – should begin to receive these drugs for the great benefit that has been shown.
9. According to these results, should the standard treatment with Dapagliflozina be replaced after the Tavi implant? In all patients?
It is an additional treatment to those currently used. It is not that I should replace others. We have not tried these SGLT2 inhibitors in the face of another drug, but we have tried what benefit it has for them to the usual treatment.
10. What do drugs against diabetes have now so many possibilities?
What is being seen with some groups of drugs is that the mechanism by which they work is not only the reduction of blood glucose, but also have many effects called metabolic. Diabetes is a metabolic disease, and therefore, any treatment that has potential metabolic effects can benefit multiple pathologies.
