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The updated label also removes the requirement that inclisiran should be used on top of or in combination with statin therapies.

FDA Approves Label Update for Inclisiran as Monotherapy for Hypercholesterolemia

Researchers explore whether or not exposure to e-cigarette or cannabis content on social media leads to increased use among adolescents.

Study Finds Social Media Exposure Associated with Adolescent Cannabis, E-Cigarette Use

For biosimilar, generic, and branded medications, Cencora researchers conducted a report detailing growth in formulary exclusions among the 3 largest pharmacy benefit managers in the US.

Top 3 PBMs Contribute to Over 1500% Increase in Formulary Exclusions Since 2014

Many treatments for hemophilia A and B are administered via intravenous infusions, so the approval offers a subcutaneous injection for the treatment for patients 12 years and older.

FDA Approves Concizumab as Daily Prophylaxis for Hemophilia A and B

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An expert discusses the increased prevalence and complexity of hyperkalemia in patients with chronic kidney disease and heart failure, emphasizing how both disease-related factors and common medications contribute to elevated potassium levels, while also highlighting the clinical trade-offs, patient lifestyle burdens, and the need for holistic, patient-centered management approaches.

Risk Factors, Epidemiology, and Patient Burden Associated With Hyperkalemia

journal explores issues within pharmacy, from the impact advocacy can have in community pharmacies to staffing shortages across multiple sectors within pharmacy. This month’s issue also explored the importance of disease awareness months and how they are opportunities to maximize valued care. Check out a preview of this month’s issue here.

download the PDF of the Total Pharmacy August 2024 issue here

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See what’s trending in pharmacy with a preview of the Total Pharmacy August issue.

Total Pharmacy

In This Issue: Total Pharmacy August 2024

Combining sodium glucose co-transporter 2 inhibitors (SGLT2is) with glucagon-like peptide-1 receptor agonists (GLP-1RAs) may offer additional protection against cardiovascular and kidney disease in patients with type 2 diabetes (T2D), according to the results of a new meta-analysis published in 

 and presented at the 61st European Renal Association Congress in Stockholm, Sweden.

Separately, SGLT2is and GLP-1RAs have demonstrated cardiovascular benefits. However, little clinical literature has focused on outcomes associated with using the medicines together. Due to the growing prevalence of GLP-1RAs in the 

 and obesity landscape, accelerated by an increasing number of indications for the agent class, this is a crucial area for further study.

The SGLT2 Inhibitor Meta-analysis Cardio-Renal Trialists’ Consortium (SMART-C) is the largest assessment of outcomes for the combined therapeutic use of SGLT2is and GLP-1RAs. The study gathered data from 12 large-scale, placebo-controlled trials of SGLT2is involving 73,238 patients with diabetes. Of these, 3065 were already receiving GLP-1RAs.

Overall, SGLT2is lowered the risk of major adverse cardiovascular events by 11% and hospitalization for heart failure or cardiovascular death by 23% compared to placebo. Notably, this benefit was seen regardless of whether patients were also taking GLP-1RAs.

When used together with GLP-1RAs, SGLT2is reduced the risk of chronic kidney disease progression by 33% and slowed the annual loss of kidney function by nearly 60%.

The study found no additional safety concerns when SGLT2is were used in combination with GLP-1RAs.

Study Reveals Robust Benefits of Semaglutide in Protecting Against Kidney, CV Events in Patients With T2D

Current meta-analysis results build off positive results of the landmark FLOW trial (

). Published earlier in May, results of the international, double-blind, randomized, placebo-controlled phase 3 trial spotlighted semaglutide’s effectiveness in lowering the risk of kidney failure, decelerating worsening kidney function, and protecting against the risk of cardiovascular events and death, in patients with T2D.

“SGLT2 inhibitors have clear protective effects against heart failure and chronic kidney disease, while GLP-1 receptor agonists can reduce the risk of heart attack, stroke, and also kidney disease—as recently demonstrated in the landmark FLOW trial,” said Brendon Neuen, lead author, clinical associate professor, senior research fellow at The George Institute for Global Health, and director of kidney trials at Sydney’s Royal North Shore Hospital, in a news release.

 “Our findings support using this combination to further improve outcomes in patients with type 2 diabetes who meet guideline recommendations for both therapies.”

Elevated glucose from diabetes can damage blood vessels in the heart and kidneys, increasing the risk of 

 and kidney disease. In fact, diabetes is the most common cause of chronic kidney disease.

Moreover, estimates predicting that T2D prevalence will more than double in the next 30 years, surpassing 1 billion global cases by 2050, further strengthen the need for research into diabetes care.

 According to Neuen in an interview with 

 conducted over email, the current study offers valuable insights for developing global treatment strategies for the condition.

"These findings, which represent the largest and most comprehensive evaluation of the combined use of SGLT2i and GLP-1RA, provides the clearest evidence yet that combined use of both medicines can further reduce cardiovascular and kidney disease," said Neuen. "We anticipate that these findings will inform how people with diabetes are treated worldwide, including influencing major clinical practice guidelines.

Although current results suggest that using SGLT2is and GLP-1RAs in tandem may offer robust protection against cardiovascular and kidney disease, further research is needed to fully understand the long-term effects of the combination therapy.

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1. Apperloo E, Neuen BL et al. Efficacy and safety of sodium glucose co-transporter 2 inhibitors with and without glucagon-like peptide-1 receptor agonists: A SMART-C collaborative meta-analysis of randomised controlled trials. 

. 2024. doi: 10.1016/S2213-8587(24)00183-9

2. Massaro L. Study reveals robust benefits of semaglutide in protecting against kidney, CV events in patients with T2D. 

https://www.drugtopics.com/view/study-reveals-robust-benefits-of-semaglutide-in-protecting-against-kidney-cv-events-in-patients-with-t2d

3. Combining popular diabetes drugs offers complementary heart and kidney benefits. News release. The George Institute for Global Health. July 9, 2024. Accessed July 10, 2024. 

https://www.georgeinstitute.org/media-releases/combining-popular-diabetes-drugs-offers-complementary-heart-and-kidney-benefits

4. Mayo Clinic Staff. Chronic kidney disease. Fact sheet. Accessed July 8, 2024. 

https://www.mayoclinic.org/diseases-conditions/chronic-kidney-disease/symptoms-causes/syc-20354521

5. Klein HE. Diabetes prevalence expected to double globally by 2050. 

https://www.ajmc.com/view/diabetes-prevalence-expected-to-double-globally-by-2050

When used together, sodium glucose co-transporter 2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) were able to lower the risk of major adverse cardiovascular events and kidney disease by 11% and 33%, respectively.

Clinical

SGLT2i, GLP-1RA Combination Therapy Offers Robust Protection Against Cardiovascular, Kidney Disease

This content is a production of Drug Topics; this Pharmacist Video is supported by funding from AstraZeneca. AstraZeneca was not involved in the creation of the content for this Video.

Hyperkalemia, or elevated potassium levels, is a relatively uncommon issue in the general population, affecting only about 2% to 3%. However, in acute care and hospitalized settings, it becomes significantly more prevalent, with roughly 10% of admitted patients experiencing it. The risk is notably higher among individuals with chronic kidney disease, particularly those also managing heart failure. The condition is often driven not only by underlying pathophysiology but also by the pharmacologic treatments used to manage these illnesses. Common drugs such as renin-angiotensin-aldosterone system inhibitors, potassium-sparing diuretics, nonsteroidal anti-inflammatory drugs, and mineralocorticoid receptor antagonists can all elevate potassium levels, especially when kidney function is impaired, making careful monitoring essential.

From a clinical standpoint, the burden of hyperkalemia affects treatment decisions. Clinicians may hesitate to fully optimize lifesaving medications, particularly for heart failure patients, out of fear of triggering hyperkalemia. This can result in suboptimal therapy, leading to poorer health outcomes and avoidable hospitalizations. While the clinical perspective often focuses on treatment limitations and risk mitigation, this approach doesn’t fully capture the patient’s lived experience or the broader impacts of the condition.

For patients, the burden of hyperkalemia extends beyond medical risks to daily life disruptions. They often face conflicting dietary advice, leading to anxiety and confusion about what they can safely eat. Managing potassium intake becomes a constant concern, impacting both the individual and their caregivers. In more severe cases, patients may require dialysis, which entails a significant time commitment and further lifestyle constraints. This complexity highlights the need for clinicians to consider both clinical guidelines and the holistic experience of the patient when managing hyperkalemia.

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Delays in hypertension diagnosis were found to be significantly common and were typically associated with delays in treatment and adverse cardiovascular outcomes, according to study data published in 

“Hypertension affects nearly 50% of individuals in the US, and its persistent elevation can lead to severe health complications,” the authors wrote. “Evidence-based guidelines emphasize the importance of early detection and treatment to mitigate the cumulative risk of adverse outcomes over time. Timely diagnosis is critical for initiating effective treatment, but the association of diagnostic delay with cardiovascular outcomes is understudied.”

When it comes to treating and diagnosing hypertension or high blood pressure (BP), a variety of organizations and trusted resources have provided guidelines on hypertension management. One of those organizations, the European Society of Hypertension, recommends a threshold greater than 140/90 mm Hg for a hypertension diagnosis, whereas the American College of Cardiology and the American Heart Association have a lower threshold at greater than 130/80 mm Hg.

FDA Approves Finerenone for Heart Failure With Left Ventricular Ejection Fraction

Regarding the current guidelines for hypertension treatment, experts recommend that either combination or monotherapy is appropriate for patients with hypertension just beginning treatment. Those therapies would include antihypertensive medications such as angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs).

 However, according to data in this Wolters Kluwer study, age, risk factors, and other characteristics can all impact a patient's hypertension treatment regimen.

Despite its global prominence, hypertension continues to go underdiagnosed for various reasons. Indeed, the researchers of the 

reported that around 30% of patients with elevated BP lacked both a formal hypertension diagnosis and a treatment regimen.

Aside from a lack of research on the underdiagnosis of hypertension, there is also a lack of knowledge on how underdiagnosis can translate to poor health outcomes.

“Despite prior research [findings] highlighting underdiagnosis of hypertension, the extent of diagnostic delay and its consequences for cardiovascular outcomes remain poorly quantified,” the authors continued.

 “This study examines how the timing of hypertension diagnosis is associated with treatment initiation and cardiovascular risk, leveraging EHR [electronic health record] data from a large regional health system. Our findings aim to provide actionable insights to support earlier intervention and improve patient outcomes.”

The researchers explored EHR data of adults aged 18 to 85 years with at least 2 outpatient BP readings of 140/90 mm Hg or more at least 30 days apart from January 1, 2010, to December 31, 2021. Participants’ hypertension diagnoses were categorized into 4 separate groups: preexisting diagnosis, diagnosed between first and second BP elevation, diagnosed after second elevation, and no recorded diagnosis.

“The primary outcome was antihypertensive medication prescription within 30 days of diagnosis,” the authors wrote.

 “The secondary outcome was the 5-year composite risk of myocardial infarction, ischemic stroke, or heart failure hospitalization.”

A total of 311,743 patients (mean age, 57.9 years; 53.3% women) with hypertension were included in the study. An official hypertension diagnosis in this study was 2 consecutive BP elevations measured within a 2-year period and at least 30 days in between readings.

Regarding the timing of patients’ hypertension diagnoses, 14.6% of the population was diagnosed after the second BP elevation. Overall, regarding hypertension’s association with patient traits, diagnoses were most common among patients of younger age, women, and those who were non-Hispanic Asian or Black.

“[The data from] this study demonstrate that delays in hypertension diagnosis are common and are associated with progressively worse patient outcomes,” the authors continued. “Delayed diagnosis was associated with a reduced likelihood of antihypertensive medication treatment and significantly increased cardiovascular risk, with the highest risk among those diagnosed more than 1 year after documented BP elevations.”

The longer patients waited for a hypertension diagnosis, the longer treatment initiation took, with the likelihood of receiving treatment decreasing as delays increased. For example, patients diagnosed within 90 days of a second BP elevation had a 54.5% chance of receiving antihypertensive medication. Those diagnosed within 90 to 365 days were 32.4% likely to receive treatment, and those diagnosed a year or more after the second elevation had a 26.4% chance of receiving treatment.

“Although a possible explanation for delayed diagnosis is infrequent health care engagement, our findings suggest otherwise. Patients with delayed hypertension diagnoses had a similar number of outpatient and primary care visits before their second elevated BP reading compared with those diagnosed earlier,” wrote the authors.

 “These findings suggest that delays were primarily due to missed clinical opportunities rather than patient disengagement from care.”

Although underdiagnosis and failure to treat at-risk individuals lead to poor health outcomes, in terms of hypertension, experts are working to make its management more easily accessible. With the discovery of the factors leading to underdiagnosis and, in turn, poor cardiovascular outcomes, researchers will look toward the EHR to further reduce risks in the future.

“In this cohort study of 311,743 adults with a computed hypertension diagnosis, delays in hypertension diagnosis were common and were associated with lower antihypertensive treatment rates and higher long-term cardiovascular risk,” they concluded.

 “Interventions leveraging EHR systems may help facilitate earlier recognition and treatment of hypertension, potentially reducing cardiovascular risk.”

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1. Lu Y, Brush JE Jr, Kim C, et al. Delayed hypertension diagnosis and its association with cardiovascular treatment and outcomes. 

. 2025;8(7):e2520498. doi:10.1001/jamanetworkopen.2025.20498

2. Vemu PL, Yang E, Ebinger J. 2023 ESH hypertension guideline update: bringing us closer together across the pond. American College of Cardiology. February 5, 2024. Accessed July 15, 2025. 

https://www.acc.org/Latest-in-Cardiology/Articles/2024/02/05/11/43/2023-ESH-Hypertension-Guideline-Update

3. Mann JFE, Flack JM. Hypertension in adults: initial drug therapy. UpToDate. Updated June 25, 2025. Accessed July 15, 2025. 

https://www.uptodate.com/contents/hypertension-in-adults-initial-drug-therapy

Researchers investigated the timing of hypertension diagnosis, exploring its association with medication prescribing and long-term cardiovascular outcomes.

Delays in Hypertension Diagnosis Common, Associated With Adverse Outcomes

Seven major clinical trials reveal semaglutide’s expanding benefits beyond glucose control, showing promise in kidney, heart, liver, vascular, and obesity-related outcomes.

Wicked Good Cardiometabolic Chat: Semaglutide’s Expanding Role in Chronic Disease

In Wicked Good Cardiometabolic Chat, a podcast offering from 

, hosts Jennifer Goldman, PharmD, CDCES, BC-ADM, FCCP, professor of pharmacy practice at Massachusetts College of Pharmacy and Health Sciences (MCPHS); and Hailey Choi, PharmD, BCACP, CDCES, associate professor of pharmacy practice at MCPHS, aim to empower pharmacists with evidence-based insights on various cardiometabolic topics. In this episode, Jen and Hailey explore 7 major clinical trials that showcase the expanding benefits of semaglutide across a range of chronic conditions.

Originally developed to manage blood glucose in type 2 diabetes, semaglutide is now being studied in kidney disease, cardiovascular disease, heart failure, liver disease, peripheral artery disease, and obesity. Data from trials such as FLOW (

) revealed impressive reductions in major kidney and cardiovascular events, while findings from STEP-HFpEF (

) highlighted improvements in quality of life and heart failure symptoms. The ESSENCE (

) trial data demonstrated liver benefits in patients with metabolic dysfunction-associated steatohepatitis (MASH), and evidence from the STRIDE (

) trial showed improved walking distance and vascular outcomes in people with peripheral artery disease.

) trial revealed that higher doses of semaglutide led to even greater weight loss, with a safety profile similar to that of lower doses. These studies reflect a broader shift in how semaglutide is viewed: not just as a glucose-lowering drug but as a potential cornerstone therapy in cardiometabolic care. Across trials, adverse effects were mostly gastrointestinal and generally mild. As evidence continues to grow, semaglutide may play a major role in how we manage chronic disease in the future.

 for insightful conversations around different cardiometabolic topics that will help improve your practice and patient care. All episodes of Wicked Good Cardiometabolic Chat will be available in video via 

, with an audio version available through Spotify.

Ralph J. Riello III, PharmD, BCPS

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