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Review
. 2023 Jun 7;15(1):118.
doi: 10.1186/s13098-023-01092-z.

Efficacy and safety evaluation of SGLT2i on blood pressure control in patients with type 2 diabetes and hypertension: a new meta-analysis

Qin Zhang  1 , Siyuan Zhou  1 , Lijun Liu  2
Affiliations
Review

Efficacy and safety evaluation of SGLT2i on blood pressure control in patients with type 2 diabetes and hypertension: a new meta-analysis

Qin Zhang et al. Diabetol Metab Syndr. .

Abstract

Background: The clinical efficacy and safety of SGLT2i in treating patients with type 2 diabetes mellitus and hypertension lack immense data support.

Objective: To systematically evaluate the clinical efficacy and safety of SGLT2i in patients with type 2 diabetes mellitus and hypertension by collecting the previously published randomized controlled trials on SGLT2i to provide data support for SGLT2i as an adjuvant in the first-line antihypertensive regimen in patients with type 2 diabetes mellitus and hypertension.

Methods: Randomized controlled trials comparing SGLT2i with a placebo in treating type 2 diabetes with hypertension were screened strictly according to inclusion and exclusion criteria. The primary efficacy endpoints included 24H systolic blood pressure, 24H diastolic blood pressure, office systolic blood pressure, and office diastolic blood pressure. The secondary efficacy endpoints included HbA1c. The safety indicators were hypoglycemia, urinary tract infection, genital infection, and renal impairment.MD was the combined effect size for continuous variables, and RR was the combined effect size for dichotomous variables.

Results: 10 RCTs with 9913 participants (6293 in the SGLT2i group and 3620 in the control group) were included for analysis.SGLT2i is effective in reducing blood pressure compared with placebo in patients with type 2 diabetes and hypertension, 24HSBP (- 5.06 mmHg, 95% CI [- 7.10, - 3.01], t = - 6.19, P < 0.05), 24HDBP (- 2.39 mmHg, 95% CI [- 4.11, - 0.67], t = - 4.15, P = 0.004), Office SBP (- 4.53 mmHg, 95% CI [- 5.66, - 3.40], t = - 9.50, P < 0.05), Office DBP (- 2.12 mmHg, 95% CI [- 3.42, - 0.82], t = - 4.88, P = 0.001). HbA1c decreased significantly (- 0.57%, 95% CI [- 0.60, - 0.54], z = 37.02, p < 0.01). SGLT2i did not increase hypoglycemia compared to placebo (RR = 1.22, 95% CI [0.916, 1.621], z = 1.36 p = 0.174), urinary tract infection (RR = 1.56, 95% CI [0.96, 2.52], z = 1.79 p = 0.073), risk of renal injury (RR = 0.78, 95% CI [0.54, 1.13], Z = 1.31, P = 0.19), but the risk of genital tract infection increased by 2.32 times (RR = 2.32, 95% CI [1.57, 3.42], Z = 4.23, P = 0.00).

Conclusion: SGLT2i can effectively control blood pressure and blood glucose and generally has high safety. For patients with type 2 diabetes mellitus and hypertension with a low risk of genital infection, SGLT2i should be considered as an adjuvant drug for a first-line antihypertensive regimen.

Keywords: Meta-analysis; SGLT2i; Type 2 diabetes and hypertension.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of literature screening
Fig. 2
Fig. 2
Literature quality assessment
Fig. 3
Fig. 3
Effect of SGLT2i on 24-h systolic blood pressure
Fig. 4
Fig. 4
Effect of SGLT2i on 24H diastolic blood pressure
Fig. 5
Fig. 5
Effect of SGLT2i on office systolic blood pressure
Fig. 6
Fig. 6
Effect of SGLT2i on office diastolic blood pressure
Fig. 7
Fig. 7
Effect of SGLT2i on HbA1c
Fig. 8
Fig. 8
Effect of SGLT2i on hypoglycemia and urinary tract infection
Fig. 9
Fig. 9
Effect of SGLT2i on genital infection and renal injury
See this image and copyright information in PMC

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