Effect of Sitagliptin on Blood Pressure and Estimated Glomerular Filtration Rate in Diabetic Patients Using an Angiotensin II Receptor Blocker

Background: Sitagliptin, a dipeptidyl peptidase-IV inhibitor, is widely used as an oral hypoglycemic agent. It may induce hemodynamic effects when interacting with angiotensin II receptor blockers. Methods: The study was conducted in an outpatient setting at Taipei Medical University Hospital. Diabetic patients who had already received angiotensin II receptor blockers for more than 6 months and then had add-on sitagliptin for another 6 months were enrolled. The blood pressures and serum creatinine levels during the 6-month period before and after onset of concomitant use of the two agents were obtained by chart reviewing. Results: Elevation of serum creatinine levels and reduction of estimated glomerular filtration rates were present after the addition of sitagliptin (p <0.05). Moreover, a trend of reduction in diastolic blood pressure was also noted. Patients with chronic kidney disease and coronary artery disease were prone to have decreased diastolic blood pressures after combined use of valsartan and sitagliptin. Patients with chronic kidney disease alone were prone to have elevation of serum creatinine levels after combined treatment of valsartan and sitagliptin. Conclusion: The addition of sitagliptin produced a trend of blood pressure lowering effects and decreased the glomerular filtration rate and HbA1c in diabetic patients using an angiotensin II receptor blocker, especially in those with chronic kidney disease.