European Society of Cardiology Updates

Volume 7, Issue 1

Reviewing the latest science from major medical meetings has become a recurring theme of Talking Therapeutics, and this week’s column is continuing that tradition. With the European Society of Cardiology (ESC) meeting recently coming to an end, there’s lots of hot science to discuss. So without further ado, let’s get started.

Point 1: SGLT2 Inhibitors are Game Changers for HFpEF

In an earlier column I mentioned that Boehringer Ingelheim had dropped a press release foreshadowing the favorable findings of the EMPEROR-Preserved trial—now we have the full trial results from ESC.

Patients were randomized in a 1:1 ratio to receive either 10 mg of empagliflozin daily (n=2997) or placebo (n=2991). During the median follow-up period of 26 months, the primary outcome of cardiovascular death or hospitalization for heart failure (HF) occurred in 13.8% of patients in the empagliflozin group (n=415) compared with 17.1% in the placebo group (n=511), a difference that was primarily due to a lower risk of HF hospitalization. The findings were consistent across all prespecified patient subgroups regardless of ejection fraction or diabetes status.

A pooled analysis was also done, called EMPEROR-Pooled, which used the EMPEROR-Reduced and EMPEROR-Preserved trials—both of which were carried out in parallel with nearly identical protocols, case report forms, investigative sites, and administrative committees. The left ventricular ejection fraction (LVEF) of the patients was the only major difference between the two trials. The pooled analysis of 9718 patients found empagliflozin reduced the risk of HF hospitalization by roughly 30% in both trials, with the magnitude of this effect being similar across a broad range of ejection fractions below 65%.

The analysis also found that empagliflozin reduced the risk of major renal outcomes in EMPEROR-Reduced, but not in EMPEROR-Preserved.

Point 2: “Step” Up to Treat Hypertension in Older Adults

The revolutionary SPRINT trial clearly established that lower blood pressure (BP) targets were effective in protecting against adverse cardiovascular outcomes in a broad cohort of patients with essential hypertension.

In the STEP trial, which was just presented at ESC, older participants (aged 60-80 years) with hypertension were randomized to intensive blood pressure management (BP target 110 to <130 mm Hg) versus standard blood pressure management (130 to <150 mm Hg). Over 8000 patients were treated for a mean of 3.3 years with olmesartan, amlodipine, and hydrochlorothiazide, as needed, to reach their blood pressure target.

The mean BP was 127.5 versus 135.3 mm Hg in the intervention versus control arm—a difference that resulted in a significant reduction in the rate of the composite of cardiovascular mortality, stroke, acute coronary syndrome, hospitalization for unstable angina, acute decompensated heart failure, coronary revascularization, or atrial fibrillation.

Dizziness and worsening of renal function were the same between treatment groups.

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