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Sodium–glucose cotransporter-2 inhibitors and blood pressure decrease

a valuable effect of a novel antidiabetic class?

Imprialos, Konstantinos P.a; Sarafidis, Pantelis A.b; Karagiannis, Asterios I.a

doi: 10.1097/HJH.0000000000000719

Diabetes mellitus is a major issue of public health, affecting more than 300 million people worldwide. Inhibitors of the sodium–glucose cotransporter-2 (SGLT-2) in the renal proximal tubule are a novel class of agents for the treatment of type 2 diabetes mellitus. Inhibition of the SGLT-2 results in reduced glucose reabsorption and improvement in glycemic control. Alongside glucose excretion, SGLT-2 inhibitors also have mild natriuretic and diuretic effects, combining actions of a proximal tubule diuretic and an osmotic diuretic; these properties are expected to lead to small blood pressure (BP) reductions. Clinical studies with dapagliflozin, canagliflozin, empagliflozin, ipragliflozin, luseogliflozin, and tofogliflozin used either as monotherapy or add-on therapy and compared with placebo or active treatment have also examined the effect of these agents on BP as a secondary endpoint. Although with some differences between individual agents, all of the approved SGLT-2 inhibitors provided a mild but meaningful reduction in office SBP and DBP. Recent studies with the use of ambulatory blood pressure monitoring suggest that the magnitude of this BP reduction can be even greater. The aim of this review is to systematically summarize and present the studies reporting the effect of approved SGLT-2 inhibitors on BP.

aSecond Propaedeutic Department of Medicine

bDepartment of Nephrology, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece

Correspondence to Pantelis A. Sarafidis, MD, MSc, PhD, Department of Nephrology, Aristotle University of Thessaloniki, Hippokration Hospital, 49 Konstantinoupoleos street, Thessaloniki 54642, Greece. Tel: +30 2310 892030; e-mail:

Abbreviations: ABPM, ambulatory blood pressure monitoring; ACEi, angiotensin-converting enzyme inhibitor; Alx, augmentation index; ARB, angiotensin II receptor blocker; BP, blood pressure; eGFR, estimated glomerular filtration rate; OAD, oral antidiabetic drug; PCT, proximal convoluted tubule; PWV, pulse wave velocity; SGLT, sodium–glucose cotransporter

Received 12 May, 2015

Revised 2 July, 2015

Accepted 2 July, 2015

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