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

Hypertension Research volume 46, pages 1892–1899 (2023)Cite this article

Abstract

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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Acknowledgements

This work was partly supported by joint funding from the Japan Diabetes Foundation and Novo Nordisk Pharma, Ltd.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Kosuke Sawami

  2. Department of Cardiovascular Medicine, Saga University, Saga, Japan

    Kosuke Sawami, Atsushi Tanaka & Koichi Node

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Correspondence to Atsushi Tanaka.

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Conflict of interest

KS declares no conflicts of interest associated with this manuscript. AT has received honoraria from Boehringer Ingelheim and research funding from GlaxoSmithKline, Takeda, Bristol Myers Squibb, and Novo Nordisk. KN has received honoraria from MSD, Astellas, AstraZeneca, Novartis, Ono, Daiichi Sankyo, Mitsubishi Tanabe, Eli Lilly, Boehringer Ingelheim, and Takeda; research grants from Asahi Kasei, Astellas, Mitsubishi Tanabe, Teijin, Terumo, Boehringer Ingelheim, Eli Lilly and Company, Mochida, and Fuji; and scholarships from Daiichi Sankyo Healthcare, Teijin, Medtronic, and Bayer.

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Sawami, K., Tanaka, A. & Node, K. Recent understandings about hypertension management in type 2 diabetes: What are the roles of SGLT2 inhibitor, GLP-1 receptor agonist, and finerenone?. Hypertens Res 46, 1892–1899 (2023). https://doi.org/10.1038/s41440-023-01324-9

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