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Mr. Li is a 55-year-old diabetic who was recently diagnosed with heart failure. To control his condition, his attending physician prescribed dapagliflozin. At his most recent follow-up visit, the doctor advised Mr. Li to switch to empagliflozin. Mr. Li was confused and did not understand why he was changing his medication. So, the doctor patiently explained to him the reason.
Weight and blood pressure control effects
In the treatment of heart failure and diabetes, weight and blood pressure management are crucial. Being overweight increases the burden on the heart, while high blood pressure can further exacerbate the symptoms of heart failure.
Dapagliflozin and empagliflozin are both SGLT2 inhibitors that are able to reduce blood sugar levels by increasing urinary glucose excretion, thereby indirectly reducing weight loss and lowering blood pressure. Studies have shown that empagliflozin is more effective in both areas.
According to a study by Toyama University Hospital, patients in the empagliflozin group lost an average of 3.2 kg of weight after 7 days of treatment, while the dapagliflozin group lost only 2.8 kg.
The reduction in systolic blood pressure was also slightly higher in the empagliflozin group than in the dapagliflozin group. For patients with heart failure, although this difference may seem small, it can significantly reduce the burden on the heart and improve the quality of life.
Neuroendocrine responses are different
The neuroendocrine system plays an important role in the management of heart failure. It directly affects the function of the heart and the progression of the disease by regulating vascular tone and fluid balance. There is a significant difference between the effects of dapagliflozin and empagliflozin in this regard.
Empagliflozin can significantly increase plasma renin activity and aldosterone concentration, whereas dapagliflozin has a limited effect in this regard. Behind this difference is the different regulatory mechanisms of the two drugs on the neuroendocrine system. Specifically, empagliflozin helps improve cardiac function and reduce heart failure symptoms through more potent diuretic and vasodilatory effects.
Empagliflozin also significantly reduces B-type natriuretic peptide (BNP) levels, an important indicator of heart failure severity, in the short term. In contrast, the effect of dapagliflozin is relatively weak. This means that patients taking empagliflozin may have greater benefit in terms of HF symptom relief and disease control.
Patient compliance and tolerability
In the long-term treatment of diabetes and heart failure, patient compliance and drug tolerance are very important considerations. No matter how good the efficacy of the drug is, if the patient cannot continue to take it or has serious adverse reactions, it is difficult to achieve the expected treatment effect. Empagliflozin shows a clear advantage in this regard.
The dosage and method of taking empagliflozin is simpler, and the once-daily dose is convenient for patients to remember and adhere to. Although dapagliflozin is also once a day, some patients report gastrointestinal discomfort during the taking process, which may affect their compliance.
In terms of tolerability, empagliflozin showed a good safety profile. According to clinical observations, patients in the empagliflozin group had fewer adverse reactions, especially in the incidence of gastrointestinal reactions and urinary tract infections. In contrast, dapagliflozin has slightly higher adverse effects in both areas, which may also be one of the reasons why doctors recommend dressing changes.
Prevention of cardiovascular events
Prevention of cardiovascular events is essential in the treatment of patients with heart failure and diabetes. Empagliflozin is particularly prominent in this regard. Several large clinical trials, including the EMPA-REG OUTCOME study, have shown that empagliflozin is effective in reducing not only heart failure hospitalizations, but also cardiovascular mortality.
Dapagliflozin, although it also had a positive effect in similar studies, was slightly less effective. For example, in the DECLARE-TIMI 58 trial, dapagliflozin, although it significantly reduced the rate of HF hospitalizations, was less effective than empagliflozin in reducing cardiovascular mortality. These findings further support the rationale for doctors recommending dressing changes.
Long-term use safety
The long-term safety of any drug is a must for clinicians and patients alike. Empagliflozin outperforms dapagliflozin in this regard, particularly in terms of renal protection and reducing the rate of progression of chronic kidney disease. Patients who take empagliflozin for a long time maintain better renal function and the rate of decline in glomerular filtration rate (eGFR) is significantly slowed.
In a DAPA-CKD trial in patients with chronic kidney disease, dapagliflozin showed a protective effect on renal function, but its effect was slightly less effective than empagliflozin. Empagliflozin is not only effective in diabetic patients, but also shows significant renal protective effect in non-diabetic patients with chronic kidney disease, which is also an important manifestation of its long-term safety.
The cardiovascular protective effect of empagliflozin has also been further validated in long-term use. This multiple protective effect makes empagliflozin the preferred recommendation for clinicians when selecting SGLT2 inhibitors, especially in patients with heart failure and diabetes who require long-term treatment.
epilogue
Through the analysis of patient compliance, cardiovascular event prevention and long-term use safety, it can be seen that empagliflozin is superior to dapagliflozin in many important clinical indicators. This not only provides a scientific basis for doctors to recommend dressing changes, but also provides patients with a more comprehensive and long-term health protection. When recommending medication changes, doctors are based on a comprehensive consideration of the patient's overall health and long-term treatment outcomes to ensure that each patient receives the best treatment plan.
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