ReviewHigh blood pressure & cardiovascular prevention : the official journal of the Italian Society of Hypertension2026
Efficacy and Safety of SGLT-2 Inhibitors in Patients with Uncontrolled or Resistant Hypertension: A Pilot Meta-Analysis of Randomized Clinical Trials.
Review in High blood pressure & cardiovascular prevention : the official journal of the Italian Society of Hypertension, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
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Abstract
introductionResistant or poorly controlled hypertension is a major contributor to cardiovascular morbidity and mortality despite contemporary multidrug regimens.
aimThis study aimed to evaluate the efficacy and safety of SGLT-2 inhibitors as adjunctive agents to standard antihypertensive therapy in this high-risk population.
methodsWe systematically searched PubMed, Embase, Google Scholar, the Cochrane Library, ScienceDirect, and ClinicalTrials.gov for randomized controlled trials (RCTs) assessing SGLT-2 inhibitors in adults with poorly controlled hypertension (on ≥2 antihypertensive agents) or resistant hypertension. Primary outcome was the mean change in office systolic blood pressure (SBP). Mean differences (MDs) were pooled for continuous outcomes, and risk ratios (RRs) were pooled for dichotomous outcomes using random-effects models.
resultsFour RCTs (n=3,718) were included in the meta-analysis. SGLT-2 inhibitors significantly reduced office SBP in both the short term (MD -3.29 mmHg, 95% CI -3.96 to -2.62) and long term (MD -2.96 mmHg, 95% CI -3.58 to -2.35). The overall incidence of adverse events (pooled RR: 0.99, 95% CI 0.95 to 1.02), serious adverse events (pooled RR: 0.92, 95% CI 0.84 to 1.00), AKI (pooled RR: 0.98, 95% CI 0.80 to 1.21), and UTI (pooled RR: 0.88, 95% CI 0.36 to 2.17) were comparable between groups. However, SGLT-2 inhibitors were associated with a significantly increased risk of volume depletion, hypotension, and genital infections.
conclusionSGLT-2 inhibitors provide a modest incremental benefit in lowering office SBP for patients with uncontrolled or resistant hypertension on multidrug regimens with an overall acceptable safety profile. Future dedicated RCTs are warranted.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.