# Cardiovascular Outcomes of SGLT-2 Inhibitors in Hypertensive Patients With and Without Diabetes: A Retrospective Observational Study

## TL;DR

This study finds that SGLT-2 inhibitors lower blood pressure and reduce cardiovascular events in hypertensive patients, both with and without diabetes, though diabetic patients face higher risks.

## Contribution

The study provides real-world evidence on cardiovascular outcomes of SGLT-2 inhibitors in hypertensive patients with and without diabetes.

## Key findings

- SGLT-2 inhibitors significantly reduced systolic and diastolic blood pressure in both diabetic and non-diabetic hypertensive patients.
- Diabetic patients experienced greater systolic blood pressure reduction compared to non-diabetic patients.
- Diabetic patients had higher rates of cardiovascular events like heart failure and myocardial infarction compared to non-diabetic patients.

## Abstract

Background

Hypertension, with or without type 2 diabetes mellitus (T2DM), is a major contributor to cardiovascular morbidity and mortality. Sodium-glucose cotransporter 2 (SGLT-2) inhibitors, originally developed for glycemic control, have demonstrated cardioprotective benefits. However, real-world data on their cardiovascular outcomes in hypertensive patients with and without diabetes remain limited.

Objectives

This study aimed to assess whether SGLT-2 inhibitor therapy improves blood pressure control and reduces cardiovascular events in hypertensive patients and to compare these outcomes between those with and without T2DM.

Methodology

This retrospective observational study was conducted at the HITEC Institute of Medical Sciences, Taxila, over 12 months. Medical records of 200 hypertensive patients prescribed SGLT-2 inhibitors were reviewed and categorized into two groups: diabetics (n = 100) and non-diabetics (n = 100). Baseline demographics, comorbidities, laboratory findings, and concomitant medications were recorded. To minimize confounding from other drugs, only patients on stable antihypertensive regimens for at least six months prior to SGLT-2 inhibitor initiation were included. Blood pressure changes were assessed from baseline to six months, and cardiovascular outcomes (hospitalization for heart failure, myocardial infarction, and all-cause mortality) were evaluated using hospital records. Statistical analysis involved paired t-tests, chi-square tests, and Cox regression models.

Results

The mean age of the participants was 56.4 ± 9.8 years, with 58% males. BMI was significantly higher in diabetics than in non-diabetics (29.2 ± 4.1 vs. 27.5 ± 3.9 kg/m², p = 0.01). As expected, diabetics had higher fasting glucose and HbA1c (p < 0.001), while lipid and renal profiles were comparable. After six months, both groups showed significant reductions in systolic and diastolic blood pressure (p < 0.001), with greater systolic reduction in diabetics (-12.5 vs. -9.7 mmHg, p = 0.04). During follow-up, diabetics experienced more cardiovascular events than non-diabetics: hospitalization for heart failure (6% vs. 3%), myocardial infarction (5% vs. 2%), and all-cause mortality (5% vs. 2%). Cox regression identified higher baseline HbA1c and longer hypertension duration as independent predictors of adverse events.

Conclusion

SGLT-2 inhibitors significantly improve blood pressure control and reduce cardiovascular events in hypertensive patients, regardless of diabetic status. However, patients with diabetes exhibit a higher residual risk, highlighting the need for integrated management strategies addressing glycemic and cardiovascular risk factors. The retrospective design allowed real-world evaluation of outcomes, though prospective studies are warranted to confirm these findings.