Cardioprotective effects of SGLT2 inhibitors are possibly associated with normalization of the circadian rhythm of blood pressure

• Published in: Hypertension research Vol. 40; no. 6; pp. 535 - 540
• Main Authors: Rahman, Asadur, Hitomi, Hirofumi, Nishiyama, Akira
• Format: Journal Article
• Language: English
• Published: England Nature Publishing Group 01.06.2017
• Subjects: Animals; Blood pressure; Blood Pressure - drug effects; Cardiovascular Diseases - prevention & control; Circadian rhythm; Circadian Rhythm - drug effects; Diabetes; Humans; Hypertension; Hypoglycemic Agents - pharmacology; Hypoglycemic Agents - therapeutic use; Inhibitor drugs; Sodium-Glucose Transporter 2; Sodium-Glucose Transporter 2 Inhibitors
• ISSN: 0916-9636; 1348-4214
• DOI: 10.1038/hr.2016.193

Improvement in cardiovascular (CV) morbidity and mortality in the EMPA-REG OUTCOME study provides new insight into the therapeutic use of sodium-dependent glucose cotransporter 2 (SGLT2) inhibitors in patients with type 2 diabetes. Although SGLT2 inhibitors have several pleiotropic effects, the underlying mechanism responsible for their cardioprotective effects remains undetermined. In this regard, the absence of a nocturnal fall in blood pressure (BP), that is, non-dipping BP, is a common phenomenon in type 2 diabetes and has a crucial role in the pathogenesis of CV morbidity and mortality. In most clinical trials, SGLT2 inhibitors reduce both systolic BP (~3-5 mm Hg) and diastolic BP (~2 mm Hg) in patients with type 2 diabetes. In addition, recent clinical and animal studies have revealed that SGLT2 inhibitors enable the change in BP circadian rhythm from a non-dipper to a dipper type, which is possibly associated with the improvement in CV outcomes in patients with type 2 diabetes. In this review, recent data on the effect of SGLT2 inhibitors on the circadian rhythm of BP will be summarized. The possible underlying mechanisms responsible for the SGLT2 inhibitor-induced improvement in the circadian rhythm of BP will also be discussed.