Gupta Rahul, Maitz Theresa, Egeler David, Mehta Anila, Nyaeme Mark, Hajra Adrija, Goel Akshay, Sreenivasan Jayakumar, Patel Neel, Aronow Wilbert S
Lehigh Valley Heart Institute, Lehigh Valley Health Network, Allentown, PA, USA.
Department of Medicine, Lehigh Valley Health Network, Allentown, PA, USA.
Trends Cardiovasc Med. 2023 Nov;33(8):479-486. doi: 10.1016/j.tcm.2022.05.005. Epub 2022 May 18.
Type 2 Diabetes Mellitus (T2DM) is a pandemic that affects millions of patients worldwide. Diabetes affects multiple organ systems leading to comorbidities including hypertension. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) recently have been approved for the treatment of T2DM and heart failure with reduced and preserved ejection fraction. Retrospective analyses of clinical trials have noted SGLT2 inhibitors to have a promising effect on blood pressure. Moreover, the observed blood pressure reduction is not just an acute effect of treatment initiation but has been shown to have a long-term impact on both systolic and diastolic blood pressure. The mechanism of action leading to the blood pressure reduction is still unclear; however, proposed mechanisms are related to the natriuretic effect, modification of the renin-angiotensin-aldosterone system, and/or the reduction in the sympathetic nervous system, SGLT2i should be considered as second-line medication in those patients with diabetes or heart disease and concomitant hypertension. This article reviews the pharmacology, side effect profile, and clinical trials surrounding the use of SGLT2i for the treatment of hypertension.
2型糖尿病（T2DM）是一种在全球范围内影响数百万患者的流行病。糖尿病会影响多个器官系统，导致包括高血压在内的合并症。钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）最近已被批准用于治疗T2DM以及射血分数降低和保留的心力衰竭。对临床试验的回顾性分析指出，SGLT2抑制剂对血压有显著影响。此外，观察到的血压降低不仅仅是治疗开始时的急性效应，而且已被证明对收缩压和舒张压都有长期影响。导致血压降低的作用机制尚不清楚；然而，提出的机制与利钠作用、肾素-血管紧张素-醛固酮系统的改变和/或交感神经系统的减少有关，SGLT2i应被视为糖尿病或心脏病合并高血压患者的二线用药。本文综述了围绕SGLT2i用于治疗高血压的药理学、副作用概况和临床试验。
