Impact of empagliflozin on blood pressure in patients with type 2 diabetes mellitus and hypertension by background antihypertensive medication
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In the EMPA-REG BP trial, empagliflozin 10 mg and 25 mg once daily reduced glycohemoglobin, blood pressure (BP), and weight versus placebo in patients with type 2 diabetes mellitus and hypertension. Patients received placebo (n=271), empagliflozin 10 mg (n=276), or empagliflozin 25 mg (n=276) for 12 weeks (n=full analysis set). This present analysis investigated changes from baseline to week 12 in mean 24-hour systolic BP (SBP) and diastolic BP (DBP) in patients receiving 0, 1, or ≥2 antihypertensive medications and patients receiving/not receiving diuretics or angiotensin-converting enzyme inhibitors/angiotensin receptor blockers. Compared with placebo, empagliflozin 10 mg and 25 mg reduced mean 24-hour SBP/DBP in patients receiving 0 (10 mg: −3.89/−2.58 mm Hg; 25 mg: −3.77/−2.45 mm Hg), 1 (10 mg: −4.74/−1.97 mm Hg; 25 mg: −4.27/−1.81 mm Hg), or ≥2 (10 mg: −2.36/−0.68 mm Hg; 25 mg: −4.17/−1.54 mm Hg) antihypertensives. The effect of empagliflozin was not significantly different between subgroups by number of antihypertensives for changes in SBP (interaction P value 0.448) or DBP (interaction P value 0.498). Empagliflozin reduced 24-hour mean SBP/DBP irrespective of diuretic or angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use, with no significant difference between subgroups by use/no use of diuretics (interaction P values 0.380 [systolic]; 0.240 [diastolic]) or angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (interaction P values 0.900 [systolic]; 0.359 [diastolic]). In conclusion, in patients with type 2 diabetes mellitus and hypertension, empagliflozin for 12 weeks reduced SBP and DBP versus placebo, irrespective of the number of antihypertensives and use of diuretics or angiotensin-converting enzyme inhibitors/angiotensin receptor blockers. Clinical Trial Registration—: URL: https://clinicaltrials.gov . Unique identifier: NCT01370005.
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SGLT2 inhibitors and GLP-1 receptor agonists used alone may not adequately control blood pressure in people with type 2 diabetes.
“The selection of medications to lower BP in persons with T2D should be guided by individual-specific considerations and may include nontraditional BP-lowering agents such as SGLT2is and GLP-1 RAs, though these drugs alone may be inadequate to control BP.”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [241]
The Abstract reports that empagliflozin, an SGLT2 inhibitor, lowers blood pressure in patients with type 2 diabetes and hypertension, including those taking no background antihypertensive medication. It also says antihypertensive monotherapy is often ineffective, but that statement is not specifically about SGLT2 inhibitors. The paper does not address GLP-1 receptor agonists or establish that either drug class alone is inadequate to achieve blood-pressure control. (LLM, conf=0.79)
Experimental — accuracy not yet measuredIn the EMPA-REG BP trial, empagliflozin reduced mean 24-hour ambulatory systolic blood pressure by approximately 3-4 mmHg after 12 weeks, with consistent reductions irrespective of the number of background blood pressure-lowering drugs.
“In the EMPA-REG BP trial, empagliflozin reduced mean 24 hour ambulatory systolic BP by approximately 3-4 mmHg after 12 weeks, 16 with consistent reductions irrespective of the number of background BP lowering drugs.17”
From Blood Pressure Effects of Canagliflozin and Clinical Outcomes in Type 2 Diabetes and Chronic Kidney Disease: Insights From the CREDENCE Trial (2021) · cites this paper as [17]
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- Authors
- Mancia, G., Cannon, C. P., Tikkanen, I., Zeller, C., Ley, L., Woerle, H. J., Broedl, U. C., & Johansen, O. E.
- Affiliations
- Brigham and Women's Hospital (US)
- ORCID
- Venue
- Hypertension
- Published
- 2016-12
- Volume
- 68
- Issue
- 6
- Pages
- 1355-1364
- ISSN
- 0194-911X (ISSN-L)
- 1524-4563
- OpenAlex
- W2530979034
- Cited by
- 128
- References
- 33
- Citations by year
- 2026: 9 · 2025: 11 · 2024: 12 · 2023: 14 · 2022: 11 · 2021: 20 · 2020: 16 · 2019: 15 · 2018: 12 · 2017: 6 · 2016: 1
- FWCI
- 9.35
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Hypertension (publishedVersion)
- PubMed (publishedVersion)
- BOA (University of Milano-Bicocca) (submittedVersion)
- INFM-OAR (INFN Catania) (submittedVersion, other-oa)
- Zenodo (CERN European Organization for Nuclear Research) (other-oa)
- Funders
- Bristol-Myers Squibb
- Eli Lilly and Company
- Pfizer
- AstraZeneca
- GlaxoSmithKline
- Sanofi
- Alnylam Pharmaceuticals
- Regeneron Pharmaceuticals
- Kowa Company
- Servier
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Keywords
- empagliflozin, type 2 diabetes, blood pressure reduction, antihypertensive drugs, diuretics, ACE inhibitors, angiotensin receptor blockers, 24-hour ambulatory blood pressure, SGLT2 inhibitors, subgroup analysis, dose comparison, weight loss, glycohemoglobin
- MeSH terms
- Antihypertensive Agents, Benzhydryl Compounds, Blood Glucose, Blood Pressure Determination, Diabetes Mellitus, Type 2, Dose-Response Relationship, Drug, Drug Administration Schedule, Female, Follow-Up Studies, Glucosides, Humans, Hypertension, Hypoglycemic Agents, Male, Prospective Studies, Reference Values, Severity of Illness Index, Comorbidity, Treatment Outcome
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