Sodium-glucose cotransporter 2 (SGLT2) inhibitors reduce systolic/diastolic blood pressure (BP) by an average of 3.62/1.70 mm Hg in 24-hour ambulatory BP, according to study results published in Diabetes Care.
The researchers searched PubMed/MEDLINE, Embase, and Cochrane from inception of each database through August 22, 2018 for randomized controlled trials that reported treatment effects of SGLT2 inhibitors on ambulatory BP. Data regarding the mean difference between the active treatment and placebo groups in change from baseline in ambulatory systolic and diastolic BP was extracted from the studies.
In total, the researchers identified 7 randomized controlled trials that involved 2381 adult participants with type 2 diabetes. Of these studies, 2 included low-dose hydrochlorothiazide as an active comparator.
Between participants given SGLT2 inhibitors and participants given placebo, the average change from baseline in 24-hour systolic BP was -3.62 mm Hg (95% CI, -4.23 to -2.94). For 24-hour diastolic BP, mean change from baseline was -1.70 mm Hg (95% CI, -2.13 to -1.26).
The results also indicated that SGLT2 inhibitors had a more potent BP-lowering effect during the daytime compared with nighttime.
Participants who received low-dose SGLT2 inhibitors showed comparable results to participants who received high-dose SGLT2 inhibitors, suggesting a flat dose-response relationship. Both of these groups had results similar to participants who received low-dose hydrochlorothiazide.
The investigators noted that the eligible randomized controlled trials did not specifically evaluate the effects of SGLT2 inhibition on cardiovascular outcomes or mortality, so the BP-lowering effects of the medication cannot be quantified by the results of this meta-analysis.
“If BP-lowering efficacy of these two drug categories is truly equal, BP lowering per se only partially explains the impressive cardioprotective action demonstrated in large-scale outcome trials testing the cardiovascular safety of [SGLT2] inhibitors,” the researchers wrote.
Georginaos PI, Agarwal R. Ambulatory blood pressure reduction with SGLT-2 inhibitors: dose-response meta-analysis and comparative evaluation with low-dose hydrochlorothiazide. Diabetes Care. 2019;42:693-700.