SGLT-2 inhibitors have modest but clinically significant blood pressure-lowering effects that are pronounced in patients with resistant hypertension.

Sodium-­glucose cotransporter-­2 (SGLT-­2) inhibitors improve glycaemic control in patients with type 2 diabetes and lower risk for adverse cardiovascular events, worsening heart failure and chronic kidney disease progression. Although SGLT-­2 inhibitors are not classified as antihypertensive agents, they have modest blood pressure (BP)-­lowering properties via a combination of effects involving diuresis, weight loss and lower sympathetic nerve activity. In this retrospective cohort study of about 13,000 adults in the Kaiser Permanente Southern California system who were already using drug therapy for hyper­tension, researchers examined the effect of SGLT-­2 inhibitors – primarily pre­scribed for diabetes management – on BP and antihypertensive medication use. Key findings were as follows:

• the average reduction in systolic BP/ diastolic BP was 5/3 mmHg; the effect was slightly greater in patients with resistant hypertension
• 13% more patients achieved a BP goal of below 130/80 mmHg after starting SGLT-­2 inhibitors
• more than one-­third of all patients used fewer antihypertensive medications after they started taking SGLT­-2 inhibitors; nearly half of the subgroup with resistant hypertension used fewer antihypertensive medications.

Comment: These findings confirm what I have seen anecdotally in my practice and are noteworthy for several reasons. The antihypertensive effects of SGLT-­2 inhibitors were even greater in patients with resistant hypertension, which is a population inherently more challenging to treat. Moreover, the observed BP effects occurred alongside a reduction in overall antihypertensive medications. Lastly, this magnitude of BP reduction is similar to that seen with aprocitentan and renal denervation, both of which are US FDA-­approved treatments for patients with hypertension. Based on these results, I will consider an SGLT-2 inhibitor more frequently as add-­on therapy for a patient with diabetes and hypertension – particularly for a patient with resistant hypertension.

Jennifer L. Cluett, MD, Assistant Professor of Medicine, Harvard Medical School, Boston, USA.

An J, et al. Blood pressure reduction and changes in antihypertensive medication use among patients with hypertension who initiated sodium-glucose cotransporter-2 inhibitors. J Clin Hypertens (Greenwich) 2024; 26: 1318-1321.

This summary is taken from the following Journal Watch titles: General Medicine, Ambulatory Medicine, Neurology.