Dipeptidyl Peptidase IV Inhibitor Therapy Modifies Systolic Blood Pressure in High Blood Pressure Diabetic Patients: Japanese Primary Prevention of Atherosclerosis With Aspirin for Diabetes (JPAD) 2 Trial

Introduction: It has been reported that dipeptidyl peptidase (DPP) IV inhibitor treatment increased glucagon like peptide (GLP)-1 and GLP-1 receptor expression levels, and subsequently endothelial nitric oxide synthase levels in experimental studies. It is possible that DPP IV inhibitors modify blood pressure (BP) through the improvement of endothelial function. Hypothesis: The aim of this study was to investigate whether DPP IV inhibitors ameliorated BP in diabetic patients. Methods: The JPAD trial, 2002 to 2008, a multicenter, prospective, randomized, open label, blinded, end-point study, was undertaken to examine the efficacy of aspirin therapy. After completion of the trial in 2008, we followed the same subjects until 2013 as JPAD2 trial cohort. BP was measured in 1244 patients in both 2009 and 2013. Among the 1244 patients, 4 patients received DPPIV inhibitors in 2009, 280 patients in 2011, 573 patients in 2013. We examined the change of BP in the 573 patients. Among them, 344 patients had systolic BP≥140 mmHg or diastolic BP≥90 mmHg or both (high BP group). Results: The systolic BP from 2009 to 2013 did not significantly change in the 1244 patients (Figure). The diastolic BP significantly decreased in the 1244 patients (Figure). The systolic BP from 2009 to 2013 did not significantly change in the 573 patients receiving DPPIV inhibitors (Figure). The diastolic BP significantly decreased in the 573 patients receiving DPPIV inhibitors (Figure). In the high BP group, the systolic BP from 2009 to 2013 significantly decreased in the 148 patients receiving DPPIV inhibitors (Figure). In the high BP group, the diastolic BP significantly decreased in the 148 patients receiving DPPIV inhibitors (Figure). Conclusions: In 4 year-observation of the JPAD2 trial cohort, diastolic BP decreased and systolic BP did not change in diabetic patients. User of DPPIV inhibitors has been dramatically increased, and it significantly modifies systolic BP in high BP diabetic patients.