Academic Scholar of the National and Kapodistrian University of Athens, 1st University Department of Cardiology, Hippokration General Hospital of Athens, 114 Vasilisis Sofias Avenue, 11525, Athens, Greece.
Department of Cardiology, Hypertension Excellence Centre-ESH, LAIKO General Hospital, Athens, Greece.
Am J Cardiovasc Drugs. 2021 Mar;21(2):123-137. doi: 10.1007/s40256-020-00423-z.
The prevalence of arterial hypertension is high in patients with diabetes mellitus (DM). When DM and hypertension coexist, they constitute a dual cardiovascular threat and should be adequately controlled. Novel antihyperglycemic agents, including sodium-glucose co-transporter 2 (SGLT-2) inhibitors, glucagon-like peptide-1 receptor agonists (GLP-1 RAs), and dipeptidyl peptidase-4 (DPP-4) inhibitors, have recently been used in the treatment of DM. Beyond their glucose-lowering effects, these drugs have shown beneficial pleiotropic cardiovascular effects, including lowering of arterial blood pressure (BP), as acknowledged in the 2019 European Society of Cardiology/European Association for the Study of Diabetes guidelines on diabetes, prediabetes, and cardiovascular diseases. The purpose of this review was to summarize the available information on the BP-reducing effects of these new glucose-lowering drug classes and provide a brief report on underlying pathophysiological mechanisms. We also compare the three drug classes (SGLT-2 inhibitors, GLP-1 RAs, and DPP-4 inhibitors) in terms of their BP-lowering effect and show that the greater BP reduction seems to be achieved with SGLT-2 inhibitors, whereas DPP-4 inhibitors have probably the mildest antihypertensive effect.
糖尿病患者的动脉高血压患病率很高。当糖尿病和高血压并存时，它们构成了双重心血管威胁，应进行充分控制。新型抗高血糖药物，包括钠-葡萄糖共转运蛋白 2（SGLT-2）抑制剂、胰高血糖素样肽-1 受体激动剂（GLP-1 RAs）和二肽基肽酶-4（DPP-4）抑制剂，最近已用于治疗糖尿病。除了降低血糖的作用外，这些药物还显示出有益的多效性心血管作用，包括降低动脉血压（BP），这在 2019 年欧洲心脏病学会/欧洲糖尿病研究协会关于糖尿病、糖尿病前期和心血管疾病的指南中得到了认可。本综述的目的是总结这些新型降糖药物类别降低血压的作用的现有信息，并简要报告潜在的病理生理机制。我们还比较了这三类药物（SGLT-2 抑制剂、GLP-1 RAs 和 DPP-4 抑制剂）在降低血压方面的效果，结果表明 SGLT-2 抑制剂似乎能更有效地降低血压，而 DPP-4 抑制剂的降压作用可能最温和。
