SGLT2 lowers BP, but more evidence is needed to use it alone

Hypertensive effect in diabetes and heart failure

Professor Cho Ik-Seong of Severance Hospital is giving a presentation (photo by Dailypharm)

There was an opinion that there is still insufficient evidence for the use of the sodium-glucose cotransporter-2 (SGLT-2) inhibitor, a treatment for type 2 diabetes and heart failure, for the treatment of hypertension.

 

It can be expected to lower blood pressure in patients with heart failure or diabetes, but it is difficult to use it alone for the treatment of hypertension.

 

Professor Cho Ik-Seong of Severance Hospital held a hypertension drug treatment update session at the '2023 Korean Society of Hypertension Spring Conference' held at EXCO in Daegu on the 20th and said, "SGLT-2 inhibitors are a drug that is attracting attention in the field of diabetes and heart failure.

 

· For patients suffering from high blood pressure, it can act as a weak blood pressure drug," he said, "but more data are needed to use it only for high blood pressure." Famous drugs for SGLT-2 inhibitors include AstraZeneca's 'Forxiga' and Eli Lilly/Boehringer Ingelheim's 'Jardiance'.

 

Recently, Daewoong Pharmaceutical's 'Envlo', Donga ST's 'Sugadapa', LG Chem's Zemidapa, and Chong Kun Dang's Exiglu M have been released, causing a sensation in the diabetes treatment market.

 

SGLT-2 inhibitor drugs are evaluated as next-generation treatments globally because they have not only blood sugar-lowering effects but also cardiovascular disease prevention, weight loss, and blood pressure-lowering effects.

 

According to the 2021 Diabetes Guidelines, in the case of type 2 diabetes accompanied by heart failure, treatment with proven cardiovascular benefit is considered first.

 

Even in the presence of atherosclerotic cardiovascular disease, SGLT-2 inhibitors are used in combination therapy.

 

The Korean Heart Failure Association completely revised the guidelines last year and recommended the administration of SGLT-2 inhibitors to reduce hospitalizations or cardiovascular deaths due to heart failure, regardless of diabetes mellitus.

 

The fact that SGLT-2 inhibitors have the effect of lowering blood pressure can be confirmed through various studies.

 

According to the 'phase 3 study on the blood pressure and blood sugar lowering effect of dapagliflozin versus placebo on antihypertensive combination therapy in patients with type 2 diabetes' published in the international journal The Lancet, the SGLT-2 inhibitor Dapagliflozin-administered group had lower blood pressure than the placebo control group.

 

The Hypertension Society also acknowledges that SGLT-2 inhibitors lower blood pressure.

 

In the hypertension treatment guidelines, SGLT-2 inhibitors have a blood pressure-lowering effect, so care should be taken to see if the dose of antihypertensive drugs needs to be adjusted.

 

Professor Ik-Sung Cho explained, "In patients without heart failure but with diabetes and high blood pressure, the use of SGLT-2 inhibitors lowered SBP by about 8 compared to placebo." Professor Cho continued, "Looking at the results of studies on patients suffering from both diabetes and heart failure, SGLT-2 inhibitors can lower SBP by 4 to 7 and diastolic blood pressure (DBP) by 1.5 to 2." -2 inhibitors are effective in lowering blood pressure, but it seems difficult to use them only for hypertension.”