Effects of sodium-glucose cotransporter 2 inhibitors on 24-hour ambulatory blood pressure: A systematic review and meta-analysis

Background- sodium-glucose cotransporter 2 (sglt2) inhibitors are a novel class of antihyperglycemic agents that improve glycemic control by increasing glycosuria. additional benefits beyond glucose lowering include significant improvements in seated clinic blood pressure (bp),partly attributed to their diuretic-like actions. less known are the effects of this class on 24-hour ambulatory bp,which is a better predictor of cardiovascular risk than seated clinic bp. methods and results- we performed a meta-analysis of randomized,double-blind,placebo-controlled trials to investigate the effects of sglt2 inhibitors on 24-hour ambulatory bp. we searched all studies published before august 17,2016,which reported 24-hour ambulatory bp data. mean differences in 24-hour bp,daytime bp,and nighttime bp were calculated by a random-effects model. sglt2 inhibitors significantly reduce 24-hour ambulatory systolic and diastolic bp by -3.76 mm hg (95% ci,-4.23 to -2.34; i2=0.99) and -1.83 mm hg (95% ci,-2.35 to -1.31; i2=0.76),respectively. significant reductions in daytime and nighttime systolic and diastolic bp were also found. no association between baseline bp or change in body weight were observed. conclusions- this meta-analysis shows that the reduction in 24-hour ambulatory bp observed with sglt2 inhibitors is a class effect. the diurnal effect of sglt2 inhibitors on 24-hour ambulatory bp may contribute to their favorable effects on cardiovascular outcomes. © 2017 the authors.