Nocturnal hypertension in diabetes: Potential target of sodium/glucose cotransporter 2 (<scp>SGLT</scp>2) inhibition

Kario, Kazuomi; Weber, Michael A.; Ferrannini, Ele

doi:10.1111/jch.13229

Cited by 20 publications

(5 citation statements)

References 22 publications

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“…Sodium‐glucose cotransporter‐2 (SGLT2) inhibitors significantly reduce 24‐hour ambulatory BP, with beneficial effects on both daytime and nighttime BP . This has been suggested to be a hemodynamic mechanism underlying the beneficial effects of SGLT2 inhibitors on heart failure in patients with diabetes . The ability of SGLT2 inhibitors to reduce 24‐hour BP in salt‐sensitive patients suggests that these agents may be suited to the management of Asian patients with hypertension.…”

Section: Resultsmentioning

confidence: 99%

Expert panel consensus recommendations for ambulatory blood pressure monitoring in Asia: The HOPE Asia Network

Kario

Shin

Chen³

et al. 2019

J of Clinical Hypertension

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130

167

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Hypertension is an important public health issue because of its association with a number of significant diseases and adverse outcomes. However, there are important ethnic differences in the pathogenesis and cardio-/cerebrovascular consequences of hypertension. Given the large populations and rapidly aging demographic in Asian regions, optimal strategies to diagnose and manage hypertension are of high importance. Ambulatory | 1251 KARIO et Al.

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Section: Resultsmentioning

confidence: 99%

Expert panel consensus recommendations for ambulatory blood pressure monitoring in Asia: The HOPE Asia Network

Kario

Shin

Chen³

et al. 2019

J of Clinical Hypertension

Self Cite

130

167

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“…The difference in reduction of nocturnal home SBP from baseline to week 4 was also of marginal statistical significance ( P = 0.054). However, this nocturnal BP reduction may be one potential mechanism for the cardioprotective action of SGLT2 inhibitors, because the lowering of nocturnal BP could act synergistically with treatment‐related reductions in circulating volume (as shown by an increase in hematocrit during empagliflozin treatment in the EMPA‐REG OUTCOME trial). This would result in reductions in both preload and afterload, contributing to lower risk of heart failure.…”

Section: Discussionmentioning

confidence: 99%

Effect of canagliflozin on nocturnal home blood pressure in Japanese patients with type 2 diabetes mellitus: The SHIFT‐J study

Kario

Okawara

Tomitani

et al. 2018

J of Clinical Hypertension

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Sodium‐glucose cotransporter 2 (SGLT2) inhibitors have beneficial effects on several cardiometabolic biomarkers, but this is not sufficient to fully explain the significant reduction in cardiovascular risk and mortality reported with SGLT2 inhibitor treatment in patients with diabetes mellitus. The 8‐week, randomized, open‐label SHIFT‐J study investigated the effects of adding canagliflozin vs intensified antihyperglycemic therapy on nocturnal home blood pressure (BP) in patients with poorly controlled type 2 diabetes and nocturnal BP on existing therapy. Patients were randomized to oral canagliflozin 100 mg/d or control (increased hypoglycemic dosage/addition of another hypoglycemic agent). The efficacy analysis included 78 patients (mean 69 years; 59% male). Nocturnal home systolic BP [HSBP] decreased by 5.23 mm Hg in the canagliflozin group and by 1.04 mm Hg in the control group (P = 0.078 for between‐group difference in change from baseline to week 8 [primary endpoint]); corresponding decreases in HSBP from baseline to week 4 were 5.08 and 1.38 mm Hg, respectively (P = 0.054). Reductions in morning HSBP from baseline to week 4 (−6.82 mm Hg vs −1.26 mm Hg, P = 0.038) and evening HSBP from baseline to week 8 (−8.74 mm Hg vs −2.36 mm Hg, P = 0.012) were greater in the canagliflozin group than in the control group. Body mass index (P < 0.001) and N‐terminal pro B‐type natriuretic peptide level (NT‐proBNP; P = 0.023) decreased more in the canagliflozin group than in the control group. Glycemic control improved comparably in both groups. Reduction of HSBP and NT‐proBNP level may be potential mechanism by which SGLT2 inhibitors reduce cardiovascular event risk.

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“…In another meta-analysis of 2,098 participants from six randomised controlled trials, treatment with SGLT2 inhibitors produced a 3.76/1.83 mmHg decline when measured by 24-h ambulatory systolic/diastolic BP monitoring (Georgianos and Agarwal, 2019). Moreover, reductions in daytime pressure were greater than those achieved overnight (Kario et al, 2018;Georgianos and Agarwal, 2019). Regarding the reasons why SGLT2 inhibitors lower BP, theoretical considerations and evidence support the effects of natriuresis and osmotic diuresis.…”

Section: Blood Pressure Decreasesmentioning

confidence: 99%

Effects of Sodium-Glucose Cotransporter 2 Inhibitors on Water and Sodium Metabolism

Tang

Yan

et al. 2022

Front. Pharmacol.

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Sodium-glucose cotransporter 2 (SGLT2) inhibitors exert hypoglycemic and diuretic effects by inhibiting the absorption of sodium and glucose from the proximal tubule. Currently available data indicate that SGLT2 inhibitors transiently enhance urinary sodium excretion and urinary volume. When combined with loop diuretics, SGLT2 inhibitors exert a synergistic natriuretic effect. The favorable diuretic profile of SGLT2 inhibitors may confer benefits to volume management in patients with heart failure but this natriuretic effect may not be the dominant mechanism for the superior long-term outcomes observed with these agents in patients with heart failure. The first part of this review explores the causes of transient natriuresis and the diuretic mechanisms of SGLT2 inhibitors. The second part provides an overview of the synergistic effects of combining SGLT2 inhibitors with loop diuretics, and the third part summarizes the mechanisms of cardiovascular protection associated with the diuretic effects of SGLT2 inhibitors.

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Nocturnal hypertension in diabetes: Potential target of sodium/glucose cotransporter 2 (SGLT2) inhibition

Cited by 20 publications

References 22 publications

Expert panel consensus recommendations for ambulatory blood pressure monitoring in Asia: The HOPE Asia Network

Expert panel consensus recommendations for ambulatory blood pressure monitoring in Asia: The HOPE Asia Network

Effect of canagliflozin on nocturnal home blood pressure in Japanese patients with type 2 diabetes mellitus: The SHIFT‐J study

Effects of Sodium-Glucose Cotransporter 2 Inhibitors on Water and Sodium Metabolism

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