Comparison of the blood pressure management between sodium glucose co-transporter 2 inhibitors and glucagon-like peptide 1 receptor agonists

Reduction in blood pressure (BP) contributes to the cardiovascular and renal protective effects of sodium-glucose co-transporter 2 inhibitors (SGLT-2is) and glucagon-like peptide 1 receptor agonists (GLP-1Ras). However, there has been no direct comparison in terms of BP-lowering efficacies. We compared the rates of achieving a target BP with SGLT-2i and GLP-1Ra treatments administered to Japanese patients with type 2 diabetes mellitus (T2DM). This retrospective study included 384 SGLT-2i- and 160 GLP-1Ra-treated patients with a BP > 130/80 mmHg before treatment. Inverse probability weighting methods using propensity scores were applied in this study. The integrated odds ratios (OR) for BP control rates were calculated and clinical changes were analyzed using a generalized linear model. SGLT-2i treatment resulted in significantly higher BP control rates than the GLP1Ra treatment (integrated OR = 2.09 [1.80, 2.43]). Compared with GLP-1Ra, SGLT-2i treatment determined significantly larger decreases in diastolic BP, mean arterial pressure, and body weight (-3.8 mmHg, P = 0.006; -4.1 mmHg, P = 0.01; and -1.5 kg, P = 0.008, respectively) and increased annual estimated glomerular filtration rate (eGFR; 1.5 mL/min/1.73 m2/year, P = 0.04). In T2DM patients with poorly controlled BP, compared with GLP-1Ra, SGLT-2i treatment significantly improved BP management along with increasing eGFR.