Explaining blood pressure reduction heterogeneity in sodium-glucose cotransporter-2 inhibitor trials: a meta-analysis stratified by patient characteristics

This meta-analysis evaluated the efficacy of sodium-glucose cotransporter-2 inhibitors (SGLT-2i) in reducing blood pressure (BP), stratified by type 2 diabetes (T2DM) and end-organ damage status. A PRISMA-compliant systematic review identified 38 RCTs ( n  = 48 828). In patients with T2DM, SBP decreased by −3.66 mmHg (95% CI: −4.16, −3.16) and DBP by −1.33 mmHg (95% CI: −1.68, −0.98). Populations without T2DM showed a significant SBP reduction of −1.79 mmHg (95% CI: −2.85, −0.72), but a nonsignificant DBP reduction. Significant antihypertensive effects were observed regardless of end-organ damage status. However, the conservative Robust Bayesian Meta-analysis (‘RoBMA’) attenuated most results to clinically trivial reductions (<2 mmHg), except in T2DM populations. Meta-regression identified T2DM and 24-h BP measurement as significant moderators for greater SBP reduction. However, baseline BP and end-organ damage were not moderators. These findings indicate the BP-lowering efficacy of SGLT-2i is most pronounced in patients with T2DM and when assessed via 24 h BP measurements.