Tikkanen Ilkka, Chilton Robert, Johansen Odd Erik
aAbdominal Center, Nephrology, University of Helsinki and Helsinki University Hospital bMinerva Institute for Medical Research, Helsinki, Finland cUniversity of Texas Health Science Center, San Antonio, Texas, USA dBoehringer Ingelheim Norway KS, Asker eDepartment of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Norway.
Curr Opin Nephrol Hypertens. 2016 Mar;25(2):81-6. doi: 10.1097/MNH.0000000000000199.
The majority of patients with type 2 diabetes mellitus (T2DM) have hypertension requiring combination therapy. Sodium glucose cotransporter 2 (SGLT2) inhibitors are novel glucose-lowering drugs with shared and potentially unique beneficial effects on cardiovascular risk beyond glycemic control. This review focuses on the potential role of SGLT2 inhibitors in the treatment of hypertension associated with T2DM.
SGLT2 inhibitors reduce office SBP by 3-5 mmHg and DBP by 2-3 mmHg across all class members. Corresponding clinically meaningful, significant blood pressure (BP) lowering effects have been confirmed using 24 h ambulatory BP monitoring. SGLT2 inhibitors reduce BP irrespective of the type of background antihypertensive medication. The antihypertensive actions of SGLT2 inhibitors involve several mechanisms including modest diuretic effects, weight loss, and direct vascular effects leading to decreased arterial stiffness and vascular resistance. The first-in class cardiovascular outcome trial with empagliflozin showed a significant reduction in a composite endpoint of cardiovascular death, nonfatal stroke, and nonfatal myocardial infarction in T2DM patients at high risk for cardiovascular events.
SGLT2 inhibitors have clinically significant antihypertensive effects. SGLT2 inhibition could be a potentially useful supplement to the BP-lowering treatment armamentarium in patients with T2DM.
大多数2型糖尿病（T2DM）患者患有高血压，需要联合治疗。钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂是新型降糖药物，除了控制血糖外，对心血管风险具有共同且可能独特的有益作用。本综述重点关注SGLT2抑制剂在治疗T2DM相关高血压中的潜在作用。
所有SGLT2抑制剂类药物均可使诊室收缩压降低3 - 5 mmHg，舒张压降低2 - 3 mmHg。通过24小时动态血压监测已证实相应的具有临床意义的显著降压效果。无论使用何种背景降压药物，SGLT2抑制剂均可降低血压。SGLT2抑制剂的降压作用涉及多种机制，包括适度的利尿作用、体重减轻以及导致动脉僵硬度和血管阻力降低的直接血管作用。恩格列净作为该类药物中的首个心血管结局试验表明，在心血管事件高危的T2DM患者中，心血管死亡、非致死性卒中和非致死性心肌梗死的复合终点显著降低。
SGLT2抑制剂具有临床显著的降压作用。SGLT2抑制可能是T2DM患者降压治疗药物库中一种潜在有用的补充。
