Dr. Roach: Jardiance is a good fit for prediabetic with heart failure

Keith Roach
To Your Health

Dear Dr. Roach: I am a 79-year-old woman who was diagnosed with heart failure six years ago. I exercise almost daily and have had low blood pressure all my life (my systolic pressure varies between the high 70s and low 100s). I have a body mass index of 22. I recently started a prediabetic diet because my blood A1C value had climbed to 6.0.

My doctor would like to prescribe the drug Jardiance. Some nasty common side effects of this drug were explained to me, and I am reluctant to take the drug. I am currently taking Cozaar and Zebeta, plus an occasional diuretic.

— E.B.

Dear E.B.: Heart failure is the inability of the heart to pump out all the blood the body needs, while allowing the blood to flow back into the heart at low pressure. There are many causes, but poorly controlled high blood pressure and multiple heart attacks are two of the most common. Neither sounds likely in your case.

Dr. Keith Roach

Some people develop an enlarged heart that doesn’t squeeze properly (called an idiopathic dilated cardiomyopathy), and viral infection is thought to be the cause of many of these cases.

Medication treatment is the mainstay of therapy for nearly all cases of heart failure. Losartan (Cozaar) helps the heart by reducing resistance to blood outflow. Bisoprolol (Zebeta) is a beta blocker, which reduces the amount of work the heart can do, which reduces risk of death from heart failure.

A new treatment for heart failure is a class of medicines called sodium-glucose cotransporter 2 (SGLT2) inhibitors, such as empagliflozin (Jardiance). These are normally used to treat diabetes, and work primarily by causing the body to lose sugar in the urine. However, they also have been proven to reduce hospitalizations and improve outcomes in people with heart failure, with or without diabetes. They do have a small increased risk of urine infection and, in women, vulvovaginal yeast infections; however, the benefits in people with heart failure are large. And, in my opinion, you should strongly consider taking the medication, especially given your A1C, which is indicative of prediabetes.

Dear Dr. Roach: When is the best time to take my losartan and hydrochlorothiazide — in the morning or evening?

— R.N.

Dear R.N.: Losartan and hydrochlorothiazide are most commonly used as treatment for high blood pressure. They are both time-tested medications and have been proven to reduce the risk of stroke in people with high blood pressure.

A large trial found that taking blood pressure medications at night led to better control of blood pressure and decreased risk of heart disease than taking the same medications during the day. But some experts have questioned the result, and additional studies are underway. Further, many people find taking a diuretic at nighttime leads to one or more visits to the bathroom at night, disrupting sleep.

Still, the best evidence now is that taking blood pressure medication at night might be better. But the jury is still out. What’s more important is to be on the right medications for you and to have your blood pressure checked regularly (such as by a high-quality home monitor).

Readers may email questions to ToYourGoodHealth@med.cornell.edu.