Title:The Beneficial Hemodynamic Actions of SGLT-2 Inhibitors beyond the Management of Hyperglycemia
Volume: 27
Issue: 39
Author(s): Charalampos Loutradis, Eirini Papadopoulou, Elena Angeloudi, Asterios Karagiannis and Pantelis Sarafidis*
Affiliation:
- Department of Nephrology, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki,Greece
Keywords:
Blood pressure, SGLT-2 inhibitors, empagliflozin, canagliflozin, dapagliflozin, Diabetes mellitus
(DM).
Abstract: Type 2 diabetes mellitus (DM) is a public health burden and its co-existence with hypertension
is long established in the context of the metabolic syndrome. Both DM and hypertension are
major risk factors, for end-stage renal disease, cardiovascular events and mortality. Strict blood pressure
(BP) control in diabetics has been associated with a cardiovascular and renal risk decrease. Inhibitors
of the sodium-glucose co-transporter 2 (SGLT-2) in the proximal tubule is a relatively novel
class of agents for the treatment of type 2 DM. Inhibition of SGLT-2 co-transporter combines proximal
tubule diuretic and osmotic diuretic action leading to glucose reabsorption reduction and mild
natriuretic and diuretic effects. On this basis, several studies showed that treatment with SGLT-2 inhibitors
can effectively decrease hyperglycemia but also increase BP control and reduce renal outcomes
and cardiovascular mortality. Based on such evidence, the recent guidelines for the management
of type 2 DM now suggest that SGLT-2 inhibitors should be preferred among oral agents in
combination with metformin, in patients at increased cardiovascular risk, chronic kidney disease or
heart failure. This review summarizes the existing data from studies evaluating the effect of SGLT-2
inhibitors on BP, and its potential value for cardio- and nephroprotection.
