PS-C19-1: EFFECTS OF COMBINED SODIUM-GLUCOSE CO-TRANSPORTER-2 INHIBITORS AND LOOP DIURETICS ON SYSTOLIC BLOOD PRESSURE: SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Background and Objective: Sodium-glucose co-transporter-2 (SGLT2) inhibitors are considered a standard of care in patients with heart failure, chronic kidney disease (CKD), and diabetes. They have substantial positive effects on cardiovascular and renal outcomes including reducing heart failure hospitalization and slowing glomerular filtration rate (GFR) decline. Loop diuretics, on the other hand, are commonly prescribed to manage volume expansion in patients with CKD and heart failure. However, the effects of combining SGLT2 inhibitors with loop diuretics are not consistent across different clinical trials. The purpose of our meta-analysis is to investigate the effect of combined SGLT2 inhibitors and loop diuretics on systolic blood pressure. Method: Using Pubmed, Scopus, Web of Science, VHL, metaRegister of Controlled Trials (mRCT), and Clinical trials.gov, a systematic review and meta-analysis of literature on the effect of adding SGLT2 inhibitors to loop diuretics on blood pressure were conducted. The comprehensive review covered randomized controlled trials (RCTs), non-randomized studies, prospective, retrospective, and post hoc investigations examining the effect of SGLT2 inhibitors on systolic blood pressure in healthy and heart failure patients. The outcome was calculated using Cohen's d formula as the standardized mean difference between the first group (SGLT2 inhibitors plus loop diuretics) and the second group (loop diuretics alone). To ensure the data's validity, a sensitivity analysis was conducted using just RCTs. Results: Eleven studies with a total of 3343 participants met all the analysis's inclusion criteria. The pooled standardized mean difference for all studies was -0.17, indicating that SGLT2 inhibitors may have a little effect on blood pressure reduction (p value = 0.06). When RCTs were excluded from the analysis, the pooled standardized mean difference was -0.10 with a p value of 0.40. Conclusion: Compared to loop diuretic alone, SGLT2 inhibitors combined with loop diuretics are not associated with a significant reduction in systolic blood pressure in patients with heart failure.