Dapagliflozin reduces the white coat effect on systolic blood pressure of patients with type 2 diabetes: a post-hoc analysis from the ADDENDA-BHS 2 trial

Background: White coat effect (WCE) is a phenomenon linked to increased cardiovascular risk, where office blood pressure readings exceed home or ambulatory measurements. Excess weight and elevated blood pressure or glucose are associated with WCE in type 2 diabetes (T2D). This study compared dapagliflozin and glibenclamide on WCE in T2D patients under equivalent blood pressure and glucose control. Methods: This post-hoc analysis of the ADDENDA-BHS2 trial enrolled T2D patients with high cardiovascular risk, defined by stable coronary artery disease or subclinical carotid atherosclerosis. This single-center, open-label, randomized trial included 98 participants, randomized to 12 weeks of dapagliflozin or glibenclamide, in addition to metformin. Baseline blood pressure and glucose control were adjusted to maintain equivalence. This analysis focused on 85 participants with pre- and post-treatment 24-h ambulatory blood pressure data. Results: Despite blood pressure and glucose control, WCE was present in 28% of participants at baseline. Baseline-adjusted change in WCE on systolic BP showed median changes of -8.6 and 1.7 mmHg for dapagliflozin and glibenclamide groups, respectively (p = 0.048). This effect was not observed on diastolic blood pressure. Conclusion: Dapagliflozin reduces WCE on systolic blood pressure compared to glibenclamide, even under equivalent blood pressure and glucose control. Clinical trial registration: The trial was registered at the Clinicaltrials.gov (NCT: 02919345).