Recent understandings about hypertension management in type 2 diabetes: What are the roles of SGLT2 inhibitor, GLP-1 receptor agonist, and finerenone?

by Selleckchem | Sep 20 2023

Diabetes and hypertension often coexist, with about half of patients with diabetes also having hypertension. The risk of cardiovascular disease increases by three to six-fold with the coexistence of diabetes and hypertension; therefore, the management of blood pressure to prevent cardiovascular disease is a particularly important issue in patients with diabetes. Clinical trial findings have resulted in recommendations to control blood pressure to <130/80 mmHg in Japanese patients with diabetes. However, the target blood pressure and selection of anti-hypertensive medications should vary depending on the duration of diabetes and comorbidities, and guidelines and clinical trial results should be interpreted flexibly to provide anti-hypertensive treatment tailored to individual patients. In recent years, a number of drugs have emerged that have significant cardio-renal protective effects in patients with diabetes, and a typical example is sodium-glucose cotransporter 2 inhibitor (SGLT2i), glucagon-like peptide-1 receptor agonist (GLP-1RA), and nonsteroidal mineralocorticoid receptor antagonist, finerenone. They have also shown modest but significant blood pressure-lowering effects. In the future, beyond considering the thresholds for how far to lower blood pressure, blood pressure management in patients with diabetes will require understanding the additive cardioprotective value of drugs aimed at lowering blood pressure and the quality of blood pressure lowering. Clinical questions of blood pressure lowering in patients with diabetes GLP-1RA, glucagon-like peptide-1 receptor agonist; SGLT2i, sodium-glucose cotransporter 2 inhibitor.

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The coexistence of diabetes and hypertension is a common occurrence, with approximately half of patients with diabetes also having hypertension. This combination significantly increases the risk of cardiovascular disease. Therefore, managing blood pressure is crucial in patients with diabetes to prevent cardiovascular complications.

Clinical trials have provided evidence to support recommendations for controlling blood pressure to levels below 130/80 mmHg in Japanese patients with diabetes. However, it's important to note that the target blood pressure and choice of anti-hypertensive medications may vary depending on factors such as the duration of diabetes and the presence of other medical conditions. Guidelines and clinical trial results should be interpreted flexibly to tailor anti-hypertensive treatment to individual patients' needs.

In recent years, several drugs have been developed that not only have significant cardio-renal protective effects in patients with diabetes but also exhibit blood pressure-lowering properties. Examples of such drugs include sodium-glucose cotransporter 2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP-1RA), and nonsteroidal mineralocorticoid receptor antagonist finerenone. These medications have shown modest yet significant effects in reducing blood pressure.

Looking ahead, managing blood pressure in patients with diabetes will involve not only considering the target thresholds for blood pressure reduction but also understanding the additional cardioprotective benefits of drugs aimed at lowering blood pressure and the overall quality of blood pressure management. This includes considering the specific effects of medications like GLP-1RA, SGLT2i, and finerenone, which have demonstrated both blood pressure-lowering and cardio-renal protective effects.

In summary, the management of blood pressure in patients with diabetes and hypertension is critical for preventing cardiovascular complications. The target blood pressure and choice of anti-hypertensive medications may vary depending on individual patient factors. Emerging drugs like GLP-1RA, SGLT2i, and finerenone have shown promise in both lowering blood pressure and providing cardio-renal protection. Future considerations should focus on optimizing blood pressure management and understanding the additional benefits of these medications.