title: Effects of sodium-glucose co-transporter 2 inhibitors on blood pressure: a systematic review and meta-analysis.
abstract: Sodium-glucose co-transporter 2 (SGLT2) inhibitors represent a new class of antihyperglycemic agents that block renal sodium and glucose reabsorption and may reduce blood pressure (BP). We assessed the BP lowering ability of these agents using meta-analytic techniques. PubMed, SCOPUS, and Cochrane Central were searched through October 2013. We included fully published randomized controlled trials (RCTs) that evaluated SGLT2 inhibitors in patients with type-2 diabetes mellitus and reported change in systolic and/or diastolic BP. Subgroup analyses were performed for placebo-controlled trials and those with active controls. We also conducted meta-regression to assess for a dose-response effect, and whether baseline BP, changes in body weight, heart rate, and hematocrit were associated with the BP effects. Twenty-seven RCTs (n = 12,960 participants) were included. SGLT2 inhibitors significantly reduced both systolic BP (weighted mean difference, -4.0 mm Hg; 95% confidence interval, -4.4 to -3.5) and diastolic BP (weighted mean difference, -1.6 mm Hg; 95% confidence interval, -1.9 to -1.3) from baseline. Only canagliflozin had a significant dose-response relationship with SBP (P = .008). Significant reductions in body weight and hematocrit were seen with the SGLTs. SGLTs had no significant effect on the incidence of orthostatic hypotension (P > .05). SGLT2 inhibitors significantly reduce BP in patients with type 2 diabetes.
authors.affiliation: Department of Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs, CT, USA. Electronic address: wbaker@uchc.edu.
authors.forename: William L
authors.initials: WL
authors.lastname: Baker
authors.affiliation: Department of Pharmacy, John Dempsey Hospital, University of Connecticut Health Center, Farmington, CT, USA.
authors.forename: Lindsay R
authors.initials: LR
authors.lastname: Smyth
authors.affiliation: Department of Pharmacy Practice, University of Mississippi School of Pharmacy, Jackson, MS, USA.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Riche
authors.affiliation: Department of Pharmacy, John Dempsey Hospital, University of Connecticut Health Center, Farmington, CT, USA.
authors.forename: Emily M
authors.initials: EM
authors.lastname: Bourret
authors.affiliation: Department of Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs, CT, USA; Department of Pharmacy, John Dempsey Hospital, University of Connecticut Health Center, Farmington, CT, USA.
authors.forename: Kevin W
authors.initials: KW
authors.lastname: Chamberlin
authors.affiliation: Division of Hypertension & Clinical Pharmacology, Department of Medicine, Calhoun Cardiology Center, University of Connecticut Health Center, Farmington, CT, USA.
authors.forename: William B
authors.initials: WB
authors.lastname: White
mesh_terms: D001794:Blood Pressure / Q000187:drug effects*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D000077203:Sodium-Glucose Transporter 2 Inhibitors
chemical_list: D007004:Hypoglycemic Agents; D000077203:Sodium-Glucose Transporter 2 Inhibitors
keywords: SGLT2 inhibitors; blood pressure; diabetes mellitus; meta-analysis