An increasing body of evidence shows that new antidiabetic drugs - particularly sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide 1 (GLP-1) receptor agonists - have a beneficial effect on cardiovascular outcome. The majority of these studies have been performed in patients with heart failure and the results have shown first positive effect on blood pressure (BP) reduction. These effects are more pronounced with SGLT2 inhibitors than with GLP-1 receptor agonists. However, the reasons and mechanisms of action inducing BP reduction are still not sufficiently clear. Proposed mechanisms of SGLT2 inhibitors involve the natriuretic effect, modification of the renin-angiotensin-aldosterone system, and/or the reduction in the sympathetic nervous system. GLP-1 receptor agonists have several mechanisms that are related to glycemic, weight, and BP control. Current data show that SGLT2 inhibitors have a stronger antihypertensive effect than GLP-1 receptor agonists, which is mainly related to their renal effect. Briefly, SGLT2 inhibitors increase the response to diuretics and decrease the meal-related antinatriuretic pressure by lowering post-prandial hyperglycemia and hyperinsulinemia and prevent proximal sodium reabsorption. SGLT2 inhibitors can be used as second-line therapy in patients with diabetes mellitus or heart disease and concomitant hypertension. This article aims to summarize current knowledge regarding the antihypertensive effect of SGLT2 inhibitors and GLP-1 receptor agonists.

An increasing body of evidence shows that new antidiabetic drugs - particularly sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide 1 (GLP-1) receptor agonists - have a beneficial effect on cardiovascular outcome. The majority of these studies have been performed in patients with heart failure and the results have shown first positive effect on blood pressure (BP) reduction. These effects are more pronounced with SGLT2 inhibitors than with GLP-1 receptor agonists. However, the reasons and mechanisms of action inducing BP reduction are still not sufficiently clear. Proposed mechanisms of SGLT2 inhibitors involve the natriuretic effect, modification of the renin-angiotensin-aldosterone system, and/or the reduction in the sympathetic nervous system. GLP-1 receptor agonists have several mechanisms that are related to glycemic, weight, and BP control. Current data show that SGLT2 inhibitors have a stronger antihypertensive effect than GLP-1 receptor agonists, which is mainly related to their renal effect. Briefly, SGLT2 inhibitors increase the response to diuretics and decrease the meal-related antinatriuretic pressure by lowering post-prandial hyperglycemia and hyperinsulinemia and prevent proximal sodium reabsorption. SGLT2 inhibitors can be used as second-line therapy in patients with diabetes mellitus or heart disease and concomitant hypertension. This article aims to summarize current knowledge regarding the antihypertensive effect of SGLT2 inhibitors and GLP-1 receptor agonists.

The clinical prognostic importance of white coat hypertension (WCH), that is, the clinical condition characterized by an increase of office but a normal ambulatory or home blood pressure (BP) is since a long time matter of considerable debate. WCH accounts for a consistent portion of hypertensive patients (up to 30–40%), particularly when hypertension is mild or age is more advanced. Although scanty and inconsistent information is available on the response of office and out-office BP to antihypertensive treatment and the cardiovascular (CV) protection provided by treatment, an increasing body of evidence focusing on the association of WCH with CV risk factors, subclinical cardiac and extra-cardiac organ damage and, more importantly, with CV events indicates that the risk entailed by this condition is intermediate between true normotension and sustained hypertension. This review will address a number of issues concerning WCH with particular attention to prevalence and clinical correlates, relation with subclinical target organ damage and CV morbidity/mortality, therapeutic perspectives. Several topics covered in this review are based on data acquired over the past 20 years by the Pressioni Arteriose Monitorate E Loro Associazioni (PAMELA) study, a longitudinal survey performed by our group on the general population living in the surroundings of Milan area in the north part of Italy.
Blood Pressure ; Humans ; Hypertension ; Italy ; Longitudinal Studies ; Prevalence ; Risk Factors ; White Coat Hypertension

The clinical prognostic importance of white coat hypertension (WCH), that is, the clinical condition characterized by an increase of office but a normal ambulatory or home blood pressure (BP) is since a long time matter of considerable debate. WCH accounts for a consistent portion of hypertensive patients (up to 30–40%), particularly when hypertension is mild or age is more advanced. Although scanty and inconsistent information is available on the response of office and out-office BP to antihypertensive treatment and the cardiovascular (CV) protection provided by treatment, an increasing body of evidence focusing on the association of WCH with CV risk factors, subclinical cardiac and extra-cardiac organ damage and, more importantly, with CV events indicates that the risk entailed by this condition is intermediate between true normotension and sustained hypertension. This review will address a number of issues concerning WCH with particular attention to prevalence and clinical correlates, relation with subclinical target organ damage and CV morbidity/mortality, therapeutic perspectives. Several topics covered in this review are based on data acquired over the past 20 years by the Pressioni Arteriose Monitorate E Loro Associazioni (PAMELA) study, a longitudinal survey performed by our group on the general population living in the surroundings of Milan area in the north part of Italy.