Factors that influence blood pressure changes with the use of sodium-glucose cotransporter 2 inhibitors in people with type 2 diabetes

Authors

• Sara Salama, Advocate Health - MidwestFollow
• Charlotte Bolch, Midwestern University, Office of Research and Sponsored Programs, Glendale, Arizona, USA.
• Dejan Landup, Advocate Health - MidwestFollow
• Elizabeth Van Dril, University of Illinois Chicago, Herbert M. And Carol H. Retzky College of Pharmacy, Chicago, Illinois, USA.
• Christie Schumacher, Midwestern University, College of Pharmacy, Downers Grove Campus, Downers Grove, Illinois, USA.Follow

Recommended Citation

Salama S, Bolch C, Landup D, Van Dril E, Schumacher C. Factors That Influence Blood Pressure Changes With the Use of Sodium-Glucose Cotransporter 2 Inhibitors in People With Type 2 Diabetes. Pharmacotherapy. 2026;46(6):e70156. doi:10.1002/phar.70156

Affiliations

Advocate Health Orland Park

Abstract

Study objective: Multiple clinical trials have reported variable reductions in blood pressure with sodium-glucose cotransporter 2 (SGLT2) inhibitors. Given the variability in the magnitude of blood pressure reduction observed across studies, there is interest in understanding how patient-specific factors influence the blood pressure-lowering effects of SGLT2 inhibitors. The primary objective of this study was to evaluate factors that influence blood pressure changes in people with type 2 diabetes when an SGLT2 inhibitor is initiated.

Design: Multicenter retrospective cohort chart review.

Data source: Patients were selected through an electronic medical record-generated report between January 1, 2013, and September 30, 2019.

Patients: Adults (≥ 18 years) receiving care within Advocate Medical Group were included if they had a documented diagnosis of type 2 diabetes and had been prescribed one of four SGLT2 inhibitors (canagliflozin, dapagliflozin, empagliflozin, or ertugliflozin) for at least 7 days.

Results: In 1,422 patients, mean systolic blood pressure (SBP) decreased by 4.1 mmHg (range -58.7 to 58.0), and mean diastolic blood pressure (DBP) decreased by 2.1 mmHg (range -44.7 to 29.0) after SGLT2 inhibitor initiation. Significant blood pressure reductions occurred only in patients with elevated baseline blood pressure, with greater declines at higher baseline pressures (p < 0.001). Patients with baseline SBP > 160 mmHg showed a mean reduction of 26.7 mmHg, whereas those with SBP < 120 mmHg had a mean increase of 6.1 mmHg. DBP followed a similar pattern: Individuals with baseline DBP > 100 mmHg had a mean reduction of 16.0 mmHg, whereas those with DBP < 60 mmHg experienced a mean increase of 10.7 mmHg.

Conclusion: Blood pressure responses to SGLT2 inhibitors were driven by baseline blood pressure, with the greatest reductions observed in patients with elevated blood pressure at initiation. Individuals with lower starting pressures showed minimal change or slight increases, indicating a normalizing effect rather than uniform blood pressure lowering with initiation of SGLT2 inhibitors. These findings support incorporating baseline blood pressure into treatment selection to optimize cardiovascular risk management in patients with type 2 diabetes.

Document Type

Article

PubMed ID

42130462