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

Hypertension and diabetes mellitus are important risk factors for cardiovascular disease. The prevalence of both diseases are still increasing. The sodium-glucose cotransporter 2 (SGLT2) inhibitor is a relatively new oral antidiabetic agent. The main mechanism of action for blood glucose lowering with this drug is through glycosuria due to its inhibiting effect on SGLT2 in nephrons. Since the action of the drug is independent from insulin, hypoglycemia is rare with an SGLT2 inhibitor. Many studies had consistently demonstrated blood pressure lowering effect of SGLT2 inhibitors, and large cardiovascular outcome trials also revealed the cardio-renal protection effect of SGLT2 inhibitors. Although the mechanisms of anti-hypertensive effect of SGLT2 inhibitors are not well established, an interplay pathway had been suggested, including diuretic effect, weight loss, improvement of arterial stiffness and endothelial dysfunction, and suppression of sympathetic over-activation.