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Blood Pressure-Lowering Effect of Newer Antihyperglycemic Agents (SGLT-2 Inhibitors, GLP-1 Receptor Agonists, and DPP-4 Inhibitors)

American Journal of Cardiovascular Drugs volume 21, pages 123–137 (2021)Cite this article

Abstract

The prevalence of arterial hypertension is high in patients with diabetes mellitus (DM). When DM and hypertension coexist, they constitute a dual cardiovascular threat and should be adequately controlled. Novel antihyperglycemic agents, including sodium-glucose co-transporter 2 (SGLT-2) inhibitors, glucagon-like peptide-1 receptor agonists (GLP-1 RAs), and dipeptidyl peptidase-4 (DPP-4) inhibitors, have recently been used in the treatment of DM. Beyond their glucose-lowering effects, these drugs have shown beneficial pleiotropic cardiovascular effects, including lowering of arterial blood pressure (BP), as acknowledged in the 2019 European Society of Cardiology/European Association for the Study of Diabetes guidelines on diabetes, prediabetes, and cardiovascular diseases. The purpose of this review was to summarize the available information on the BP-reducing effects of these new glucose-lowering drug classes and provide a brief report on underlying pathophysiological mechanisms. We also compare the three drug classes (SGLT-2 inhibitors, GLP-1 RAs, and DPP-4 inhibitors) in terms of their BP-lowering effect and show that the greater BP reduction seems to be achieved with SGLT-2 inhibitors, whereas DPP-4 inhibitors have probably the mildest antihypertensive effect.

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Affiliations

  1. Academic Scholar of the National and Kapodistrian University of Athens, 1st University Department of Cardiology, Hippokration General Hospital of Athens, 114 Vasilisis Sofias Avenue, 11525, Athens, Greece

    Charalampos I. Liakos

  2. Department of Cardiology, Hypertension Excellence Centre-ESH, LAIKO General Hospital, Athens, Greece

    Dimitrios P. Papadopoulos, Elias A. Sanidas, Maria L. Velliou & John D. Barbetseas

  3. 1st Department of Internal Medicine, NIMTS Hospital, Athens, Greece

    Maria I. Markou

  4. 2nd Department of Internal Medicine, Attikon General Hospital, Athens Medical School, Athens, Greece

    Erifili E. Hatziagelaki

  5. Department of Cardiology, Hypertension Excellence Centre-ESH, KAT General Hospital, Athens, Greece

    Charalampos A. Grassos

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  1. Charalampos I. Liakos
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The initial idea for the article belongs to DPP. All authors contributed to the study conception and design. CIL, DPP, EAS, and MIM conducted the literature search and analyzed and interpreted the data. CIL wrote the first draft of the manuscript, and all authors commented on previous versions of the manuscript and contributed to the critical revision and editing of the manuscript. Supervision was performed by DPP and JDB. All authors read and approved the final manuscript.

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Correspondence to Charalampos I. Liakos.

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Charalampos I. Liakos, Dimitrios P. Papadopoulos, Elias A. Sanidas, Maria I. Markou, Erifili E. Hatziagelaki, Charalampos A. Grassos, Maria L. Velliou, and John D. Barbetseas have no conflicts of interest that are directly relevant to the content of this article.

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Liakos, C.I., Papadopoulos, D.P., Sanidas, E.A. et al. Blood Pressure-Lowering Effect of Newer Antihyperglycemic Agents (SGLT-2 Inhibitors, GLP-1 Receptor Agonists, and DPP-4 Inhibitors). Am J Cardiovasc Drugs 21, 123–137 (2021). https://doi.org/10.1007/s40256-020-00423-z

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  • DOI: https://doi.org/10.1007/s40256-020-00423-z