Available online 12 March 2024

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Teaching points:

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SGLT2 inhibitors have been shown to significantly reduce both systolic and diastolic blood pressure in individuals with type 2 diabetes and hypertension.

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SGLT2 inhibitors have been shown to slow the progression of CKD and its associated problems as well as reduce HHF and CV Death risks, which are elevated in individuals with diabetes and hypertension.

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Additionally, SGLT2 inhibitors offer benefits beyond blood pressure reduction, including weight loss and improvements in HbA1C levels.

ABSTRACTBackground

Sodium-glucose cotransporter 2 (SGLT2) inhibitors, initially developed for type 2 diabetes treatment, have shown potential benefits beyond glycemic control, including a positive impact on blood pressure. This meta-analysis aims to evaluate their effects on patients with type 2 diabetes and hypertension.

Methods

We searched PubMed, Google Scholar, and Cochrane databases for relevant randomized controlled trials (RCTs) published until May 31, 2023. Ten RCTs involving participants with confirmed Type 2 diabetes mellitus were selected. The intervention group received SGLT2 inhibitors, while the control group received a placebo or standard care. Primary outcomes were 24-hour ambulatory systolic and diastolic blood pressures.

Results

The results showed a significant reduction in 24-hour ambulatory systolic blood pressure (WMD = -5.08 mmHg, 95% CI: -7.02 to -3.14, p <0.00001) and diastolic blood pressure (WMD = -2.73 mmHg, 95% CI: -4.25 to –1.20, p = 0.0005) with the use of SGLT2 inhibitors compared to placebo. However, high heterogeneity was observed in both analyses (systolic blood pressure: I2 = 83%; diastolic blood pressure: I2 = 91%). Sensitivity analysis excluding specific studies reduced heterogeneity while maintaining statistically significant and clinically meaningful reductions in blood pressure.

Conclusion

In conclusion, this meta-analysis proves that SGLT2 inhibitors significantly reduce 24-hour ambulatory blood pressure. SGLT2 inhibitors may be considered an effective treatment option for lowering blood pressure in addition to standard care in hypertensive patients with type 2 diabetes mellitus.

Section snippetsINTRODUCTION

According to the 2023 American Diabetes Association (ADA), individuals with diabetes are considered to have hypertension if their systolic blood pressure is 140 mmHg or higher or if their diastolic blood pressure is 90 mmHg or higher [1]. Patients with diabetes have a high probability (67-78%) of developing cardiovascular disease throughout their lifetime [2]. The coexistence of hypertension further amplifies this heightened cardiovascular risk, as two-thirds of diabetic patients are

MATERIAL AND METHODS

This meta-analysis adhered to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines [16]. We began by formulating a protocol outlining the research question, inclusion/exclusion criteria, and search strategy. Employing PRISMA's recommendations, we systematically searched diverse databases using keywords like 'SGLT2 inhibitors,' 'type 2 diabetes,' and 'ambulatory blood pressure.' Following PRISMA's checklist, we rigorously ensured transparent study selection,

Inclusion criteria

We only considered double-arm, randomized, controlled trials (RCTs) that had participants with confirmed type 2 diabetes mellitus and hypertension. The intervention of interest was SGLT2 inhibitors, compared to standard care or placebo. The primary outcomes analyzed were 24-hour ambulatory systolic and diastolic blood pressures. In contrast, secondary outcomes included daytime and nighttime blood pressures, office seated blood pressures, glycated hemoglobin levels, and body weight.

Exclusion criteria

Only articles

Study selection

A total of 218 articles were identified from the preliminary literature search. After eliminating duplicated articles and thoroughly reading full-text articles, a total of 10 RCTs [7, 18, 19, 20, 21, 22, 23, 24, 25, 41] were included in this meta-analysis. The step by step study selection process is summarized in Figure 1.

Baseline characteristics

A total of 2747 participants meeting clinical definitions of hypertension and type 2 diabetes were enrolled in 10 placebo-controlled double-blinded investigations. Of these,

DISCUSSION

Our meta-analysis aimed to explore the impact of sodium-glucose cotransporter 2 (SGLT2) inhibitors on 24-hour ambulatory blood pressure in patients with type-2 diabetes and hypertension. We analyzed 2747 patients across ten studies and consistently observed significant reductions in 24-hour ambulatory systolic blood pressure (SBP) and diastolic blood pressure (DBP) following SGLT2 inhibitor treatment. Seven studies had a 12-week follow-up [7, 18, 21, 22, 23, 24, 38], one had a 6-week follow-up [

CONCLUSION

In conclusion, our meta-analysis affirms that sodium-glucose cotransporter 2 (SGLT2) inhibitors significantly lower 24-hour ambulatory blood pressure in patients type-2 diabetes that have hypertension. These reductions align with prior studies, emphasizing SGLT2 inhibitors as effective blood pressure lowering agents. Beyond blood pressure control, SGLT2 inhibitors yield additional benefits, such as weight loss and improvements in HbA1C levels. Hence, SGLT2 inhibitors may be considered as an

Declarations of interest:

None

Disclosures:

The authors report no proprietary or commercial interest in any product mentioned or concept discussed in the article.

Uncited reference

27., 27..

Declaration of interests

☒ The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

☒The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: none.

Acknowledgements:

None

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