The effect of SGLT2 inhibitors on blood pressure in relation to baseline kidney function: A systematic literature review and data analysis.

Background: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) reduce both systolic blood pressure (SBP) and diastolic blood pressure (DBP). The glucose-lowering effect of SGLT2i depends on baseline estimated glomerular filtration rate (eGFR), but whether the same is true for the blood pressure lowering effect is unknown.

Methods: We performed a systematic literature review in PubMed (Study 1) and analysed data from a clinical study (Study 2) to investigate if the blood pressure lowering effect of SGLT2i depends on baseline eGFR. In the literature review, we performed a weighted regression analysis with mean change in SBP and DBP as dependent variables and mean eGFR as an independent variable. Furthermore, we analyzed data from a cohort of 48 patients with either type 2 diabtes mellitus with and without chronic kidney disease (CKD) or non-diabetic CKD with varying degrees of kidney function.

Results: 2069 articles were identified of which 27 articles met the inclusion criteria. Analysis revealed a mean weighted reduction in SBP -4.7 mmHg compared to baseline and -3.5 mmHg compared to placebo. The weighted regression analysis showed no correlation between change in SBP and baseline eGFR. Data analysis of 48 patients revealed a SBP reduction of 5.5 mmHg and the simple linear regression revealed no correlation between the decrease in blood pressure and baseline eGFR.

Conclusions: The blood pressure lowering effect of SGLT2i does not depend on baseline eGFR.