Related Experiment Video
Updated: May 15, 2026

Evaluation of Cerebral Blood Flow Autoregulation in the Rat Using Laser Doppler Flowmetry
Published on: January 19, 2020
Factors That Influence Blood Pressure Changes With the Use of Sodium-Glucose Cotransporter 2 Inhibitors in People
Sara Salama1, Charlotte Bolch2, Dejan Landup3
1Advocate Health, Orland Park, Illinois, USA.
Study Objective:
Multiple clinical trials have reported variable reductions in blood pressure with sodium-glucose cotransporter 2 (SGLT2) inhibitors. Given the variability in the magnitude of blood pressure reduction observed across studies, there is interest in understanding how patient-specific factors influence the blood pressure-lowering effects of SGLT2 inhibitors. The primary objective of this study was to evaluate factors that influence blood pressure changes in people with type 2 diabetes when an SGLT2 inhibitor is initiated.
Design:
Multicenter retrospective cohort chart review.
Data Source:
Patients were selected through an electronic medical record-generated report between January 1, 2013, and September 30, 2019.
Patients:
Adults (≥ 18 years) receiving care within Advocate Medical Group were included if they had a documented diagnosis of type 2 diabetes and had been prescribed one of four SGLT2 inhibitors (canagliflozin, dapagliflozin, empagliflozin, or ertugliflozin) for at least 7 days.
Results:
In 1,422 patients, mean systolic blood pressure (SBP) decreased by 4.1 mmHg (range -58.7 to 58.0), and mean diastolic blood pressure (DBP) decreased by 2.1 mmHg (range -44.7 to 29.0) after SGLT2 inhibitor initiation. Significant blood pressure reductions occurred only in patients with elevated baseline blood pressure, with greater declines at higher baseline pressures (p < 0.001). Patients with baseline SBP > 160 mmHg showed a mean reduction of 26.7 mmHg, whereas those with SBP < 120 mmHg had a mean increase of 6.1 mmHg. DBP followed a similar pattern: Individuals with baseline DBP > 100 mmHg had a mean reduction of 16.0 mmHg, whereas those with DBP < 60 mmHg experienced a mean increase of 10.7 mmHg.
Conclusion:
Blood pressure responses to SGLT2 inhibitors were driven by baseline blood pressure, with the greatest reductions observed in patients with elevated blood pressure at initiation. Individuals with lower starting pressures showed minimal change or slight increases, indicating a normalizing effect rather than uniform blood pressure lowering with initiation of SGLT2 inhibitors. These findings support incorporating baseline blood pressure into treatment selection to optimize cardiovascular risk management in patients with type 2 diabetes.
Related Concept Videos
Factors affecting Blood pressure
Physiological Factors:
Antihypertensive Drugs: Action of Diuretics
Diabetes Mellitus: Type 2 and Gestational
Type II Diabetes I: Introduction
Type II Diabetes II: Pathophysiology
Hypertension and Regulation of Blood Pressure