Changes in Systolic and Diastolic Blood Pressure Following SGLT2 Therapy in Diabetic Patients with Kidney Impairment

Background: Blood pressure reduction is an early hemodynamic response to sodium–glucose cotransporter-2 (SGLT2) inhibitors, although its magnitude varies among patients. This study evaluated clinical factors associated with blood pressure response following SGLT2 inhibitor therapy in patients with type 2 diabetes mellitus (T2DM) and kidney impairment. Methods: A retrospective cohort study was conducted using electronic medical records from two secondary healthcare centers. A total of 254 patients received SGLT2 inhibitor monotherapy (n=119), metformin monotherapy (n=124), or combination therapy (n=11). Demographic, clinical, laboratory, and blood pressure data were collected at baseline and follow-up. Blood pressure changes were assessed using the Wilcoxon signed-rank test and compared among treatment groups using the Kruskal–Wallis test. Spearman correlation and multiple linear regression were used to identify factors associated with ΔSBP and ΔDBP. Results: Median SBP decreased from 145.0 (IQR 27) to 129.5 (IQR 26) mmHg, with a median change of −15.5 mmHg (P<0.001). Median DBP decreased from 90.0 (IQR 16) to 80.0 (IQR 12) mmHg, with a median change of −10.0 mmHg (P<0.001). Greater blood pressure reductions were observed among patients receiving SGLT2 inhibitor monotherapy (both P<0.001). Age, diabetes duration, HbA1c change, and triglyceride change were associated with ΔSBP, while age and diabetes duration were associated with ΔDBP. Short-term eGFR changes were not independently associated with either outcome. Conclusions: SGLT2 inhibitor therapy was associated with reductions in blood pressure. Blood pressure response was associated mainly with patient-specific clinical and metabolic characteristics rather than short-term changes in kidney function.