Are SGLT2 Inhibitors Reasonable Antihypertensive Drugs and Renoprotective?

• Published in: Current hypertension reports Vol. 17; no. 6; p. 551
• Main Authors: Lovshin, J. A., Gilbert, R. E.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-06-2015; Springer Nature B.V
• Subjects: Antihypertensive Agents - pharmacology; Antihypertensive Agents - therapeutic use; Cardiology; Cytoprotection; Diabetes Complications - metabolism; Family Medicine; General Practice; Humans; Hypertension; Hypertension - drug therapy; Internal Medicine; Kidney - drug effects; Medicine; Medicine & Public Health; Metabolic Diseases; Nephrology; Primary Care Medicine; Section Editor; Sodium-Glucose Transporter 2 - antagonists & inhibitors; Sodium-Glucose Transporter 2 - metabolism; Therapeutic Trials (M Weir; Topical Collection on Therapeutic Trials; Diabetic nephropathy; Sodium-glucose-linked cotransporter-2; Blood pressure; Tubuloglomerular Feedback; Diabetes mellitus
• ISSN: 1522-6417; 1534-3111
• DOI: 10.1007/s11906-015-0551-3

By eliminating glucose in the urine, the sodium-glucose-linked cotransporter-2 (SGLT2) inhibitors act as osmotic diuretics to lower blood pressure in addition to reducing plasma glucose and assisting with weight loss. While not approved as antihypertensive agents, the ability of this new class of antihyperglycemic agents to lower blood pressure is not insubstantial, and while not used primarily for this indication, they may assist diabetic individuals in attaining currently recommended blood pressure targets. In addition to lowering systemic pressure, preclinical and exploratory human studies suggest that SGLT2 inhibitors may also lower intraglomerular pressure, potentially reducing the rate of GFR decline in patients with diabetic nephropathy. However, given the lack of clinically meaningful endpoint data, the use of SGLT2 inhibitors, primarily, as either antihypertensive or renoprotective agents would, at present, be premature. Fortunately, further insight will be garnered from large, randomized controlled trials that will assess the effects of various SGLT2 inhibitors on cardiovascular and renal outcomes.