Efficacy and mechanistic insights of dapagliflozin in hypertension management

Hypertension remains one of the leading modifiable risk factors for cardiovascular disease and premature mortality worldwide. Blood pressure (BP) management is particularly challenging in patients with coexisting type 2 diabetes (T2D), chronic kidney disease (CKD), or heart failure (HF). Sodium-glucose cotransporter 2 (SGLT2) inhibitors have become an integral component of contemporary cardiorenal therapy and have consistently demonstrated additional BP-lowering effects across diverse clinical settings. This narrative review synthesizes the current clinical evidence regarding the antihypertensive effects of dapagliflozin and summarizes the biological mechanisms that may contribute to these effects, including osmotic diuresis and natriuresis, weight reduction, modulation of the sympathetic nervous system, enhanced uric acid excretion, and attenuation of oxidative stress, inflammation, and vascular dysfunction. Across clinical studies, reductions in systolic BP (SBP) generally exceed those in diastolic BP (DBP), although the physiological basis underlying this differential response remains incompletely understood. Dapagliflozin has demonstrated good tolerability and antihypertensive effects in clinical applications, its long-term use may be limited by the risk of genital infections. Collectively, the available evidence supports dapagliflozin as a cardiorenal therapeutic agent that may provide additional BP-lowering benefits in patients with hypertension and concomitant T2D, CKD, or HF, rather than as a substitute for conventional antihypertensive therapy. Future hypertension-focused clinical studies are warranted to further define its role in hypertension management.