SGLT2 inhibitors reduce the salt sensitivity of blood pressure in type 2 diabetes via enhanced postprandial natriuresis
Authors' conclusion
In T2D, treatment with SGLT2 inhibitors is associated with a reduced BP response to high sodium intake, accompanied by enhanced postprandial sodium and water excretion, along with attenuated neurohormonal activation. These findings identify physiological associations that may contribute to the BP-lowering and cardiovascular protective effects of SGLT2 inhibition.
Study context
- Population
- Patients with T2D; very-low-sodium background diet plus high sodium (HS) (+ 4,800 mg/day) or low sodium (LS) (+ 1,200 mg/day) sodiumcompleted both phases
- Participants
- 26 patients
- Comparison
- SGLT2i treatment vs controls under HS vs LS diet
- SGLT2in = 14
- Controlsn = 12reference
- Primary endpoint
- Salt sensitivity of blood pressure (BP): change in 24-h ambulatory SBP between HS and LS diets
- Follow-up
- 7-day dietary phases
Methodological detailsopen-label, non-randomized, sequential 7-day dietary phases
- Open-label
- Non-randomized
- Sequential 7-day dietary phases
Primary result
As reported in the abstract
Δ24-h SBP between HS and LS diets
Controls
+5.6
median · IQR 2.0–20.3 · mmHg
SGLT2i
−1.2
median · IQR −3.6–4.2 · mmHg
P = 0.007 between groups
- Within-group change, controls
- P = 0.005
- Within-group change, SGLT2i
- P = 0.594
Further findings
| Outcome | SGLT2i | Controls | P value |
|---|---|---|---|
| Δ24-h DBP between HS and LS dietsMedian, mmHg | −1.2 (IQR −3.1–1.4) | +4.6 (IQR 1.3–9.8) | P = 0.002 between groups |
| Postprandial natriuresis, HS dietMedian, µEq/min | 55.0 (IQR 28.3–126.6) | −0.7 (IQR −148.6–109.0) | P = 0.049 |
| Postprandial natriuresis, LS dietMedian, µEq/min | 18.4 (IQR 1.3–42.2) | −14.5 (IQR −30.2–15.7) | P = 0.046 |
| Postprandial diuresis, HS dietMedian, ml/min | 0.52 (IQR 0.10–1.18) | −0.21 (IQR −0.58–0.45) | P = 0.041 |
Renin, aldosterone, hydration and glycosuria
- Renin and aldosterone increased markedly on LS diet in controls but not in SGLT2i-treated patients
- Hydration and glycosuria unchanged and unrelated to natriuretic responses
Original publication
SGLT2 inhibitors reduce the salt sensitivity of blood pressure in type 2 diabetes via enhanced postprandial natriuresis. Cardiovasc Diabetol. Published 24 February 2026. doi:10.
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