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Meta-Analysis
. 2017 May 18;6(5):e005686.
doi: 10.1161/JAHA.117.005686.

Effects of Sodium-Glucose Cotransporter 2 Inhibitors on 24-Hour Ambulatory Blood Pressure: A Systematic Review and Meta-Analysis

William L Baker  1 , Leo F Buckley  2 , Michael S Kelly  3 , John D Bucheit  2 , Eric D Parod  2 , Roy Brown  4 , Salvatore Carbone  5   6 , Antonio Abbate  5 , Dave L Dixon  7
Affiliations
Meta-Analysis

Effects of Sodium-Glucose Cotransporter 2 Inhibitors on 24-Hour Ambulatory Blood Pressure: A Systematic Review and Meta-Analysis

William L Baker et al. J Am Heart Assoc. .

Abstract

Background: Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a novel class of antihyperglycemic agents that improve glycemic control by increasing glycosuria. Additional benefits beyond glucose lowering include significant improvements in seated clinic blood pressure (BP), partly attributed to their diuretic-like actions. Less known are the effects of this class on 24-hour ambulatory BP, which is a better predictor of cardiovascular risk than seated clinic BP.

Methods and results: We performed a meta-analysis of randomized, double-blind, placebo-controlled trials to investigate the effects of SGLT2 inhibitors on 24-hour ambulatory BP. We searched all studies published before August 17, 2016, which reported 24-hour ambulatory BP data. Mean differences in 24-hour BP, daytime BP, and nighttime BP were calculated by a random-effects model. SGLT2 inhibitors significantly reduce 24-hour ambulatory systolic and diastolic BP by -3.76 mm Hg (95% CI, -4.23 to -2.34; I2=0.99) and -1.83 mm Hg (95% CI, -2.35 to -1.31; I2=0.76), respectively. Significant reductions in daytime and nighttime systolic and diastolic BP were also found. No association between baseline BP or change in body weight were observed.

Conclusions: This meta-analysis shows that the reduction in 24-hour ambulatory BP observed with SGLT2 inhibitors is a class effect. The diurnal effect of SGLT2 inhibitors on 24-hour ambulatory BP may contribute to their favorable effects on cardiovascular outcomes.

Keywords: ambulatory blood pressure monitoring; diabetes mellitus; diabetic therapy/glitazones; high blood pressure; hypertension; metformin; sodium‐glucose cotransporter 2 inhibitors.

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Figures

Figure 1
Figure 1
PRISMA diagram of study selection process. ABPM indicates ambulatory blood pressure monitoring; DM, type 2 diabetes mellitus; RCT, randomized, controlled trial; Tx, treatment.
Figure 2
Figure 2
Effect of SGLT2 inhibitors on 24‐hour systolic blood pressure. CANA indicates canagliflozin; DAPA, dapagliflozin; EMPA, empagliflozin; ERTU, ertugliflozin; MD, mean difference; SBP, systolic blood pressure; SGLT2, sodium‐glucose cotransporter 2 inhibitor.
Figure 3
Figure 3
Contour‐enhanced funnel plots of 24‐hour systolic blood pressure.
Figure 4
Figure 4
Effect of SGLT2 inhibitors on 24‐hour diastolic blood pressure. CANA indicates canagliflozin; DAPA, dapagliflozin; DBP, diastolic blood pressure; EMPA, empagliflozin; ERTU, ertugliflozin; MD, mean difference; SGLT2, sodium‐glucose cotransporter 2 inhibitor.
Figure 5
Figure 5
Contour‐enhanced funnel plots of 24‐hour diastolic blood pressure.
Figure 6
Figure 6
Effect of SGLT2 inhibitors on daytime systolic blood pressure. CANA indicates canagliflozin; DAPA, dapagliflozin; EMPA, empagliflozin; ERTU, ertugliflozin; MD, mean difference; SBP, systolic blood pressure; SGLT2, sodium‐glucose cotransporter 2 inhibitor.
Figure 7
Figure 7
Effect of SGLT2 inhibitors on daytime diastolic blood pressure. CANA indicates canagliflozin; DAPA, dapagliflozin; DBP, diastolic blood pressure; EMPA, empagliflozin; ERTU, ertugliflozin; MD, mean difference; SGLT2, sodium‐glucose cotransporter 2 inhibitor.
Figure 8
Figure 8
Effect of SGLT2 inhibitors on nighttime systolic blood pressure. CANA indicates canagliflozin; DAPA, dapagliflozin; EMPA, empagliflozin; ERTU, ertugliflozin; MD, mean difference; SBP, systolic blood pressure; SGLT2, sodium‐glucose cotransporter 2 inhibitor.
Figure 9
Figure 9
Effect of SGLT2 inhibitors on nighttime diastolic blood pressure. CANA indicates canagliflozin; DAPA, dapagliflozin; DBP, diastolic blood pressure; EMPA, empagliflozin; ERTU, ertugliflozin; MD, mean difference; SGLT2, sodium‐glucose cotransporter 2 inhibitor.
See this image and copyright information in PMC

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