The anti-hypertensive effects of sodium-glucose cotransporter-2 inhibitors

Expert Rev Cardiovasc Ther. 2023 Jan;21(1):15-34. doi: 10.1080/14779072.2023.2159810. Epub 2022 Dec 22.


Introduction: Hypertension is a well-established risk factor for cardiovascular (CV) events in patients with chronic kidney disease (CKD), heart failure, obesity, and diabetes. Despite the usual prescribed antihypertensive therapies, many patients fail to achieve the recommended blood pressure (BP) targets.

Areas covered: This review summarizes the clinical BP-lowering data presented in major CV and kidney outcome trials for sodium-glucose cotransporter-2 (SGLT2) inhibitors, as well as smaller dedicated BP trials in high-risk individuals with and without diabetes. We have also highlighted potential mechanisms that may contribute to the antihypertensive effects of SGLT2 inhibitors, including natriuresis and hemodynamic changes, a loop diuretic-like effect, and alterations in vascular physiology.

Expert opinion: The antihypertensive properties of SGLT2 inhibitors are generally modest but may be larger in certain patient populations. SGLT2 inhibitors may have an additional role as an adjunctive BP-lowering therapy in patients with hypertension at high risk of CV disease or kidney disease.

Keywords: SGLT2 inhibitors; chronic kidney disease; diabetes; heart failure; hypertension.

Publication types

  • Review

MeSH terms

  • Antihypertensive Agents / pharmacology
  • Antihypertensive Agents / therapeutic use
  • Cardiovascular Diseases* / drug therapy
  • Cardiovascular Diseases* / etiology
  • Cardiovascular Diseases* / prevention & control
  • Diabetes Mellitus, Type 2* / complications
  • Diabetes Mellitus, Type 2* / drug therapy
  • Glucose / therapeutic use
  • Glucosides / pharmacology
  • Humans
  • Hypertension* / drug therapy
  • Hypoglycemic Agents / therapeutic use
  • Sodium / therapeutic use
  • Sodium-Glucose Transporter 2 Inhibitors* / pharmacology
  • Sodium-Glucose Transporter 2 Inhibitors* / therapeutic use


  • Antihypertensive Agents
  • Sodium-Glucose Transporter 2 Inhibitors
  • Glucosides
  • Glucose
  • Sodium
  • Hypoglycemic Agents