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Blood Pressure Effects of SGLT2 Inhibitors: Mechanisms and Clinical Evidence in Different Populations

  • Antihypertensive Agents: Mechanisms of Drug Action (M Ernst, Section Editor)
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Abstract

Purpose of Review

Sodium glucose transporter 2 inhibitors (SGLT2 inhibitors) are increasingly prescribed due to their considerable benefits on clinical outcomes in people with diabetes, heart failure, and chronic kidney disease (CKD). Hypertension is a common comorbidity in each of these disease states, increasing risk of cardiovascular morbidity and mortality. We herein review the effects of SGLT2 inhibitors on blood pressure in different populations, proposed mechanisms of action, and the contribution of blood pressure lowering to end-organ protection.

Recent Findings

A recognised effect of SGLT2 inhibitors in recent clinical trials is blood pressure lowering, with multiple postulated mechanisms. This advantageous effect was first identified in populations with type 2 diabetes mellitus, prior to expansion of these trials to broader cohorts.

Summary

On our review, we identified that the blood pressure lowering effect of SGLT2 inhibitors appears to be a dose-independent class-effect, with a magnitude of effect comparable to that seen with a low dose hydrochlorothiazide. There is considerable evidence demonstrating that this effect is observed across populations including those with type 2 diabetes mellitus, chronic kidney disease, and resistant hypertension.

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Declaration is not applicable.

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Authors and Affiliations

  1. Department of Renal Medicine, Royal North Shore Hospital, Sydney, Australia

    Bryony Beal & Brendon L. Neuen

  2. The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Level 5, 1 King St Newtown 2042, Sydney, Australia

    Aletta E. Schutte & Brendon L. Neuen

  3. School of Population Health, University of New South Wales, Sydney, Australia

    Aletta E. Schutte

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Contributions

B.B., A.S. and B.N. wrote the main manuscript text. B.B. and B.N. prepared all figures and tables. B.N. is the corresponding author. All authors reviewed the manuscript.

Corresponding author

Correspondence to Brendon L. Neuen.

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Conflict of Interest

Authors BB and AS declare that they have no conflicts of interest. Author BLN has received fees for advisory boards, steering committee roles, scientific presentations, and travel support from AstraZeneca, Bayer, Boehringer and Ingelheim, Cambridge Healthcare Research, the Limbic, Medscape, and Janssen, with all honoraria paid to his institution. He serves as Secretariat of the SGLT2 Inhibitor Meta-Analysis Cardio-Renal Trialists Consortium.

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Beal, B., Schutte, A.E. & Neuen, B.L. Blood Pressure Effects of SGLT2 Inhibitors: Mechanisms and Clinical Evidence in Different Populations. Curr Hypertens Rep 25, 429–435 (2023). https://doi.org/10.1007/s11906-023-01281-1

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