Baslé Lucile, Maigret Lucie, Dupont Vincent, Lièvre Loïc, Bouvier Nicolas, Duthe Fabien, Perrin Peggy, Jaureguy Maïté, Golbin Léonard, Garrouste Cyril, Rerolle Jean-Philippe, Bertrand Dominique, Rieu Philippe, Gatault Philippe, Deliège Pierre-Guillaume
Service de Néphrologie, Transplantation et Dialyse, CHU de Reims, Reims, France.
Service de Néphrologie-Hypertension, Dialyse, Transplantation Rénale, CHRU Tours, Tours, France.
Clin Hypertens. 2025 Sep 1;31:e26. doi: 10.5646/ch.2025.31.e26. eCollection 2025.
Blood pressure (BP) control remains a therapeutic challenge in kidney transplant recipients (KTRs). Sodium-glucose cotransporter-2 inhibitors (SGLT2is) lower BP in diabetic and chronic kidney disease patients. Whether this effect extents to KTRs remains to be fully established. We explored the BP lowering potential of SGLT2i, by examining their effects on BP and their influence on antihypertensive drugs prescriptions.
Using the French observational multicenter ASTRE database, we collected systolic BP (SBP), diastolic BP (DBP), weight and drugs, at baseline and at 3 and 6 months after SGLT2i initiation. To evaluate the impact of SGLT2i on other anti-hypertensive drugs management, we used metric such as the defined daily dose (DDD) and the hypertensive index (HTi).
Two hundred thirty-four patients were included in the analysis, nearly all had hypertension and 63% had diabetes. By the 3-month mark, there was a significant 4 mmHg reduction in SBP and DBP, which was sustained at 6 months, with decreases of 2.5 mmHg and 3 mmHg (respectively for SBP and DBP). The DDD remained stable. HTi decreased by 14 and 9.5 points at 3 and 6 months, respectively. In multivariate analysis, female sex was associated with a more significant reduction in SBP and HTi.
In KTRs newly treated with SGLT2i, BP decreased at 3 and 6 months, while the overall antihypertensive load, as assessed by DDD, remained stable. Similar effects were observed on HTi. These findings suggest SGLT2i as an effective adjunctive therapy for lowering BP in hypertensive KTRs, regardless of diabetes status.
血压控制仍是肾移植受者（KTRs）面临的治疗挑战。钠-葡萄糖协同转运蛋白2抑制剂（SGLT2is）可降低糖尿病和慢性肾病患者的血压。这种作用是否适用于KTRs仍有待充分证实。我们通过研究SGLT2i对血压的影响及其对抗高血压药物处方的影响，探讨了其降低血压的潜力。
利用法国多中心观察性ASTRE数据库，我们收集了SGLT2i开始治疗时、治疗3个月和6个月时的收缩压（SBP）、舒张压（DBP）、体重和药物使用情况。为了评估SGLT2i对其他抗高血压药物管理的影响，我们使用了限定日剂量（DDD）和高血压指数（HTi）等指标。
234例患者纳入分析，几乎所有人都患有高血压，63%患有糖尿病。到3个月时，SBP和DBP显著降低4 mmHg，6个月时仍持续降低，SBP和DBP分别降低2.5 mmHg和3 mmHg。DDD保持稳定。HTi在3个月和6个月时分别下降了14和9.5个点。多变量分析显示，女性性别与SBP和HTi的更显著降低相关。
在新接受SGLT2i治疗的KTRs中，3个月和6个月时血压下降，而通过DDD评估的总体抗高血压负荷保持稳定。HTi也观察到类似效果。这些发现表明，SGLT2i是降低高血压KTRs血压的有效辅助治疗方法，无论其糖尿病状态如何。
