Background: Diabetes mellitus type 2 (T2DM) often co-exists with hypertension, and this aggregation
of co-morbidities amplifies the risk for future cardiovascular events. Therefore, it appears crucial to understand
the essence of choosing oral and non-insulin injectable anti-diabetic drugs (ADs) with a favorable hemodynamic
impact that could partially attenuate the increased baseline cardiovascular risk.
Objective: We sought to evaluate the effect of ADs on blood pressure (BP) indices and to assess the potential role
of certain ADs towards hypertension treatment.
Method: We performed a systematic review of the literature searching MEDLINE via Pubmed for all human
studies implementing ADs, either individually or in combinations.
Results: Metformin was found to reduce BP in small cohorts but failed to confirm its beneficial effect in a metaanalysis
of 41 studies. Thiazolidinediones are associated with BP lowering but are contraindicated in patients with
heart failure. Sulfonylureas, on the other hand, may increase BP, while a-glucosidase inhibitors, DPP-4 inhibitors,
and SGLT2 inhibitors activate favorable pathophysiologic mechanisms serving as potential BP lowering agents.
Relevant BP reduction was established for GLP-1 Ras in most clinical trials.
Conclusion: The favorable hemodynamic impact of certain classes of ADs might provide synergistic or incremental
therapeutic benefits in high-risk patients suffering from both T2DM and hypertension. Additional randomized
trials designed under the hypothesis of the emerging beneficial hemodynamic effect of ADs are expected to
provide more robust evidence and to guide the optimization of combined treatment strategies in this challenging
group of patients.