Objective To evaluate the efficacy and safety of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in patients with type 2 diabetes mellitus (T2DM) and hypertension(HBP). Methods Randomized controlled trials(RCTs) of SGLT-2 inhibitors in the treatment of patients with type 2 diabetes mellitus complicated with hypertension published up to April 30, 2025 were searched through PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang, and VIP databases. Document screening, information extraction and literature quality evaluation were respectively done by two researchers through inclusion and exclusion criteria, and RevMan 5.3 software for data analysis. The primary outcome indicators were 24-hour ambulatory systolic blood pressure(SBP), 24-hour ambulatory diastolic blood pressure(DBP), office-seated SBP, office-seated DBP, and adverse reactions such as hypoglycaemia, urinary tract infection, genital infection, and hypovolaemia. Results A total of 10 RCTs were included. The results showed that compared with placebo group,the SGLT2i group significantly reduced 24-hour ambulatory systolic blood pressure (WMD=-4.78,95% CI:-6.31~-3.25,P＜0.000 01) and 24-hour ambulatory diastolic blood pressure (WMD=-2.57,95% CI:-3.85~-1.29,P＜0.000 01). However, high levels of heterogeneity were observed in both analyses (SBP, I2=85%; DBP, I2=94%). Sensitivity analyses after excluding specific studies reduced heterogeneity, but still had a statistically significant reduction in blood pressure(P＜0.000 01). At the same time, office-seated SBP levels in patients with T2DM and hypertension were significantly reduced in the SGLT2i group compared with placebo group(WMD=-4.98,95% CI:-6.64~-3.32,P＜0.000 01). In addition, SGLT-2 inhibitors in combination with conventional antihypertensive regimens were associated with an increased risk of hypoglycaemia (RR=1.85,95%CI:1.09~3.13,P＜0.05) and genital infections (RR=2.48,95%CI:1.26~4.87,P＜0.05); there was no statistically significant difference in the incidence of hypovolaemia (RR=1.85,95%CI:1.09~3.13,P＜0.05) and urinary tract infection (RR=1.74,95%CI:0.9~3.39,P＞0.05) compared with conventional antihypertensive combined with placebo. Conclusions SGLT2i can reduce 24-hour ambulatory blood pressure and more significant systolic blood pressure in patients with T2DM and HBP, with more significant reduction in systolic blood pressure, but it is necessary to pay attention to the risk of hypoglycaemia and genital infection. For patients with hypertension and type 2 diabetes, SGLT2i can be an effective antihypertensive treatment option in addition to standard therapy.
Key words
sodium-glucose cotransporter 2 inhibitor /
hypertension /
type 2 diabetes mellitus /
safety /
efficacy
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