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Vildagliptin, metformin increase heart rate after meals in type 2 diabetes
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The DPP-IV inhibitor vildagliptin and metformin may both lead to an increased heart rate after eating in adults with type 2 diabetes, but the agents had different blood pressure effects, according to findings published in Diabetes Care.
Tongzhi Wu, MD, PhD, of the NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health at the University of Adelaide in Australia, and colleagues conducted two separate studies to determine the effects of vildagliptin and metformin on BP and heart rate response to intraduodenal glucose in adults with type 2 diabetes.
In the first study, researchers evaluated 16 adults (11 men; mean age, 65.5 years) with diet-controlled type 2 diabetes (mean diabetes duration, 5.1 years; mean HbA1c, 6.3%) randomly assigned to vildagliptin 50 mg or placebo. The nine participants who had been prescribed antihypertension drugs underwent a 24-hour washout period. On four occasions, participants ingested their study drug followed by an intraduodenal infusion at either 2 kcal or 4 kcal per minute after an overnight fast.
Both systolic and diastolic BP decreased promptly and recovered slowly, and heart rate and superior mesenteric artery blood flow increased to a plateau during intraduodenal glucose infusion (P for time effect < .001). Compared with placebo, participants assigned to vildagliptin had lower mean systolic BP (P = .002) and diastolic BP (P < .001); no difference was found between the second and fourth intraduodenal glucose infusions. Compared with the second infusion, the fourth was associated with higher heart rate (P= .003), and heart rate was further increased with vildagliptin compared with placebo (P = .005).
In the second study, researchers evaluated nine men (mean age, 63.8 years) with type 2 diabetes (mean diabetes duration, 3.6 years; mean HbA1cm 6.6%) randomly assigned to metformin 850 mg or placebo for 7 days. The three participants who had been prescribed antihypertension drugs underwent a 24-hour washout period. Participants were administered an intraduodenal glucose infusion at 2 kcal per minute on two occasions.
Compared with placebo, participants assigned to metformin had higher heart rate (P for treatment effect < .001), whereas no difference was found for systolic or diastolic BP. Systolic and diastolic BP decreased and heart rate increased during the intraduodenal glucose infusion (P for time effect < .001).
“Postprandial BP should be monitored in patients with type 2 diabetes, since it is associated with postprandial hypotension,” Wu told Endocrine Today. “The findings in our studies were made during a non-physiological condition, where glucose was infused directly into the small intestine. Further studies using a physiological meal for evaluation of DPP-IV inhibitors on postprandial BP and heart rate responses in people with type 2 diabetes are needed to validate the findings.” – by Amber Cox
For more information:
Tongzhi Wu, MD, PhD, can be reached at The University of Adelaide, Level 6 Eleanor Harrald Building, Royal Adelaide Hospital, North Terrance, Adelaide SA 5000; email: tongshi.wu@adelaide.edu.au.
Disclosure: Wu reports receiving research funding from AstraZeneca and travel support for Novartis. Please see the full study for a list of all other authors’ relevant financial disclosures.
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