Key result
SGLT2i in T2D linked to a ~4 mmHg SBP drop, greater at higher baselines.
Why the study?
Given variable blood pressure reductions observed across clinical trials, there was interest in evaluating patient-specific factors that influence blood pressure changes when initiating an SGLT2 inhibitor in people with type 2 diabetes.
Does baseline blood pressure influence the magnitude of blood pressure changes when an SGLT2 inhibitor is initiated in adults with type 2 diabetes?
Cohort (n=1,422)
Yes
Does baseline blood pressure influence the magnitude of blood pressure changes when an SGLT2 inhibitor is initiated in adults with type 2 diabetes?
p-value: p=< 0.001
SGLT2 inhibitors exert a normalizing effect on blood pressure in patients with type 2 diabetes, with significant reductions seen primarily in those with elevated baseline pressures.
SGLT2 inhibitors were associated with SBP reduction in real-world patients; extends trial data but leaves open outcome implications.
STUDY OBJECTIVE: Multiple clinical trials have reported variable reductions in blood pressure with sodium-glucose cotransporter 2 (SGLT2) inhibitors. Given the variability in the magnitude of blood pressure reduction observed across studies, there is interest in understanding how patient-specific factors influence the blood pressure-lowering effects of SGLT2 inhibitors. The primary objective of this study was to evaluate factors that influence blood pressure changes in people with type 2 diabetes when an SGLT2 inhibitor is initiated. DESIGN: Multicenter retrospective cohort chart review. DATA SOURCE: Patients were selected through an electronic medical record-generated report between January 1, 2013, and September 30, 2019. PATIENTS: Adults (≥ 18 years) receiving care within Advocate Medical Group were included if they had a documented diagnosis of type 2 diabetes and had been prescribed one of four SGLT2 inhibitors (canagliflozin, dapagliflozin, empagliflozin, or ertugliflozin) for at least 7 days. RESULTS: In 1,422 patients, mean systolic blood pressure (SBP) decreased by 4.1 mmHg (range -58.7 to 58.0), and mean diastolic blood pressure (DBP) decreased by 2.1 mmHg (range -44.7 to 29.0) after SGLT2 inhibitor initiation. Significant blood pressure reductions occurred only in patients with elevated baseline blood pressure, with greater declines at higher baseline pressures (p < 0.001). Patients with baseline SBP > 160 mmHg showed a mean reduction of 26.7 mmHg, whereas those with SBP < 120 mmHg had a mean increase of 6.1 mmHg. DBP followed a similar pattern: Individuals with baseline DBP > 100 mmHg had a mean reduction of 16.0 mmHg, whereas those with DBP < 60 mmHg experienced a mean increase of 10.7 mmHg. CONCLUSION: Blood pressure responses to SGLT2 inhibitors were driven by baseline blood pressure, with the greatest reductions observed in patients with elevated blood pressure at initiation. Individuals with lower starting pressures showed minimal change or slight increases, indicating a normalizing effect rather than uniform blood pressure lowering with initiation of SGLT2 inhibitors. These findings support incorporating baseline blood pressure into treatment selection to optimize cardiovascular risk management in patients with type 2 diabetes.
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Salama et al. (2026) conducted a cohort in type 2 diabetes (n=1,422). SGLT2 inhibitors was evaluated on blood pressure changes (p=< 0.001). SGLT2 inhibitor initiation in type 2 diabetes reduced mean systolic blood pressure by 4.1 mmHg, with significantly greater reductions observed in patients with higher baseline pressures (p < 0.001).
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