Blood Pressure-Lowering Effects of SGLT2 Inhibitors and GLP-1 Receptor Agonists.

PURPOSE OF REVIEW: Hypertension is the leading modifiable risk factor for cardiovascular disease. Despite multiple antihypertensive therapies, blood pressure (BP) control remains suboptimal in many individuals with persistent cardiovascular risk. This review evaluates the antihypertensive potential of sodium-glucose cotransporter-2 inhibitors (SGLT2-i) and glucagon-like peptide-1 receptor agonists (GLP-1RA), particularly in patients with comorbid diabetes, HF, CKD or resistant hypertension.

RECENT FINDINGS: SGLT2-i consistently lower office SBP/DBP (2.5-4.0/1.5-2.0 mmHg) and 24-hour ambulatory BP (3.8/1.8 mmHg). GLP-1RAs show modest SBP reductions (1.8-5.1 mmHg) and minimal DBP effects (~ 0.5 mmHg), though tirzepatide shows greater efficacy (~ 10.6 mmHg) in select populations. Both classes have demonstrated cardio-renal benefits, favorable safety profiles, and reduced polypharmacy. SGLT2-i exert more consistent BP-lowering effects than GLP-1RA, largely due to their diuretic-like action. While not first-line therapies, both drug classes show promise as adjuncts in high-risk populations. Future research should further define their role in comprehensive hypertension management.