Blood Pressure‐Lowering Effect of SGLT2 Inhibitors in Patients Without Antihypertensive Treatment: A Real‐World Data Analysis

ABSTRACT Sodium‐glucose co‐transporter 2 (SGLT2) inhibitors have demonstrated blood pressure (BP)‐lowering effects; however, most studies included patients taking antihypertensive medications. Using real‐world Japanese data, we assessed factors associated with SGLT2 inhibitor‐mediated BP reduction in patients not taking antihypertensive therapy. After excluding those taking antihypertensive medications, we retrospectively analyzed 6,988 patients newly prescribed SGLT2 inhibitors (2014‒2023). BP was evaluated using health check‐up data before and after SGLT2 inhibitor prescription. The mean patient age was 61.6 years, and 66.8% were male. Systolic/diastolic BP were reduced by 2.3±7.6/2.3±8.4%, respectively, following SGLT2 inhibitor initiation. Multiple regression analysis identified baseline systolic BP as the strongest predictor (R 2 = 8.83%), while BMI change was substantially associated with SBP reduction (R 2 = 2.76%). Compared with a propensity score‐matched cohort of DPP‐4 inhibitor new users, greater BP reduction was observed in the SGLT2 inhibitor group, with differences of 2.3%/2.1% for systolic/diastolic BP. An ≈2% BP reduction may occur following SGLT2 inhibitor initiation.