September 10, 2026European Heart Journal
SGLT2 inhibitors and diuretics in heart failure: clicking reset on the renal volume setpoint?
Key result
SGLT2 inhibitors provide a robust, evidence-based treatment for patients with heart failure and preserved ejection fraction.
Key Points
- To discuss the role and therapeutic mechanisms of SGLT2 inhibitors alongside diuretics in managing renal volume setpoints for heart failure with preserved ejection fraction.
- Clinical review and synthesis of pharmacological evidence regarding sodium-glucose cotransporter-2 (SGLT2) inhibition.
- Evaluation of volume regulation and diuretic interactions in heart failure with preserved ejection fraction (HFpEF).
- SGLT2 inhibitors demonstrate robust, evidence-based efficacy in heart failure with preserved ejection fraction, replacing prior consensus-only management.
- Therapy influences renal volume regulation, effectively resetting fluid setpoints when paired with conventional diuretic regimens.
Structured PICO
P
Population
Patients with heart failure (HF) and preserved ejection fraction (HFpEF)
I
Intervention
Sodium glucose cotransporter-2 (SGLT2) inhibitors and diuretics
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“In light of this physiology, SGLT2 inhibitors probably should be conceptualized not as diuretics but rather as modulators of the volume set point. This vantage point allows us to reconcile the lack of excess risk of volume depletion reported with these agents with the observation of improved volume status and reduction in volume overload-associated events such as HF hospitalization.”
Implication
SGLT2 inhibitors provide a robust, evidence-based treatment for patients with HFpEF.
Abstract
After years of treatment decisions based upon expert consensus alone, patients with heart failure (HF) and preserved ejection fraction (HFpEF) finally have a robust, evidence-based treatment in the sodium glucose cotransporter-2 (SGLT2) inhibitors. 1
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Cite This Study
Borlaug et al. (2023) studied this question. SGLT2 inhibitors provide a robust, evidence-based treatment for patients with heart failure and preserved ejection fraction.