SGLT2 inhibitors reduce the salt sensitivity of blood pressure in type 2 diabetes via enhanced postprandial natriuresis
Abstract
Background: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) lower blood pressure (BP) and provide cardiovascular protection. In animal models, SGLT2i blunt sodium-induced BP elevation, but this effect remains unexplored in humans. We investigated whether SGLT2i reduce the salt sensitivity of BP in patients with type 2 diabetes (T2D) and explored the underlying mechanisms.
Methods: In an open-label, non-randomized study, 26 patients with T2D (14 on treatment with SGLT2i, 12 controls) completed two sequential 7-day dietary phases consisting of a very-low-sodium background diet with the addition of either high sodium (HS, + 4,800 mg/day) or low sodium (LS, + 1,200 mg/day). Changes in twenty-four hour ambulatory BP monitoring (24-hour ABPM), postprandial natriuresis and diuresis, plasma renin and aldosterone concentrations, glycosuria, and hydration were assessed.
Results: The median change in systolic BP between HS and LS diets was greater in controls (median [IQR] Δ24-h SBP: +5.6 [2.0, 20.3] mmHg, p = 0.005), than in the SGLT2i group (Δ24-h SBP: -1.2 [-3.6, 4.2] mmHg, p = 0.594; p = 0.007 between groups). Diastolic BP changes showed similar patterns (Δ24-h DBP: +4.6 [1.3, 9.8] mmHg vs. -1.2 [-3.1, 1.4] mmHg; p = 0.002 between groups). SGLT2i-treated participants showed enhanced postprandial natriuresis during both HS (median [IQR]: 55.0 [28.3, 126.6] µEq/min vs. -0.7 [-148.6, 109.0] µEq/min; p = 0.049) and the LS diet (18.4 [1.3, 42.2] µEq/min vs. -14.5 [-30.2, 15.7]…
How strong is the evidence?
Evidence Hub reads this as a clinical trial, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 26 participants or records.
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