Blood pressure effects of SGLT2 inhibitors and GLP-1 receptor agonists: Mechanisms, trial evidence and Real-world data

Abstract

Sodium–glucose cotransporter 2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have transformed the management of type 2 diabetes, obesity and cardiorenal disease. Beyond their established glycaemic and weight-lowering effects, both drug classes consistently lower blood pressure (BP), a benefit that remains relatively underrecognized. This review provides an integrated synthesis of trial evidence, real-world data and meta-analyses examining the antihypertensive effects of SGLT2is and GLP-1 RAs. Across cardiovascular, heart failure, renal and obesity trials, modest but clinically meaningful BP reductions have been observed in diverse populations, including individuals without diabetes. These effects appear largely independent of glycaemic control and offer additive value in high-risk patients with overlapping comorbidities. The totality of evidence supports the strategic incorporation of these agents into future antihypertensive frameworks, warranting further investigation in dedicated blood pressure–focused trials.