Antihypertensive Wirkungen von SGLT-2-Inhibitoren und GLP-1-Rezeptoragonisten

Zusammenfassung

Die GLP-1-Rezeptoragonisten und die SGLT-2-Inhibitoren sind als Antidiabetika entwickelt worden und haben mittlerweile einen festen Stellenwert in der Nephroprotektion und der Behandlung der Herzinsuffizienz, unabhängig vom Vorliegen eines Diabetes mellitus. Beide Substanzgruppen senken auch den Blutdruck bei Hypertonikern. Die Blutdrucksenkung ist ein willkommener Effekt bei Patienten, die unter kombinierten Störungen leiden. Die GLP-1-Rezeptoragonisten dürften vor allem durch die Gewichtsabnahme den Blutdruck senken. Die SGLT-2-Inhibitoren wirken wahrscheinlich überwiegend durch ihre natriuretischen und diuretischen Effekte. Die GLP-1-Rezeptoragonisten haben bei Hypertonie mit obstruktiver Schlafapnoe günstige Effekte. Der Einsatz beider Substanzen bietet sich an, wenn neben einer Hypertonie Krankheitsbilder bestehen, bei denen diese Substanzgruppen von gesichertem Nutzen sind. Dies kann zu einer Verbesserung der Blutdruckeinstellung oder zur Einsparung von Antihypertensiva führen. Sowohl die SGLT-2-Inhibitoren als auch die GLP-1-Rezeptoragonisten haben ursprünglich als Antidiabetika Eingang in unser therapeutisches Arsenal gefunden. Wenig später stellte sich heraus, dass beide Substanzgruppen unabhängig von ihrer antidiabetischen Wirkung wichtige nephro- und kardioprotektive Eigenschaften haben.

Publication History

Article published online:
07 November 2025

• Literatur

• 1 Aronne LJ, Horn DB, Le Roux CW. et al. Tirzepatide as Compared with Semaglutide for the Treatment of Obesity. N Engl J Med 2025; 393: 26-36
• 2 Stefanou I M-, Palaiodimou L, Theodorou A. et al. Risk of major adverse cardiovascular events and all-cause mortality under treatment with GLP-1 RAs or the dual GIP/GLP-1 receptor agonist tirzepatide in overweight or obese adults without diabetes: a systematic review and meta-analysis. Ther Adv Neurol Disord 2024; 17 17562864241281903
• 3 Sattar N, Lee MMY, Kristensen SL. et al. Cardiovascular, mortality, and kidney outcomes with GLP-1 receptor agonists in patients with type 2 diabetes: a systematic review and meta-analysis of randomised trials. Lancet Diabetes Endocrinol 2021; 9: 653-662
• 4 Husain M, Bain SC, Jeppesen OK. et al. Semaglutide (SUSTAIN and PIONEER) reduces cardiovascular events in type 2 diabetes across varying cardiovascular risk. Diabetes Obes Metab 2020; 22: 442-451
• 5 Lincoff AM, Brown-Frandsen K, Colhoun HM. et al. Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes. N Engl J Med 2023; 389: 2221-2232
• 6 Kosiborod MN, Abildstrøm SZ, Borlaug BA. et al. Semaglutide in Patients with Heart Failure with Preserved Ejection Fraction and Obesity. N Engl J Med 2023; 389: 1069-1084
• 7 Packer M, Zile MR, Kramer CM. et al. Tirzepatide for Heart Failure with Preserved Ejection Fraction and Obesity. N Engl J Med 2025; 392: 427-437
• 8 Perkovic V, Tuttle KR, Rossing P. et al. Effects of Semaglutide on Chronic Kidney Disease in Patients with Type 2 Diabetes. N Engl J Med 2024; 391: 109-121
• 9 Apperloo EM, Gorriz JL, Soler MJ. et al. Semaglutide in patients with overweight or obesity and chronic kidney disease without diabetes: a randomized double-blind placebo-controlled clinical trial. Nat Med 2025; 31: 278-285
• 10 Yin Y, Zhang M, Cao Q. et al. Efficacy of GLP-1 Receptor Agonist-Based Therapies on Cardiovascular Events and Cardiometabolic Parameters in Obese Individuals Without Diabetes: A Meta-Analysis of Randomized Controlled Trials. J Diabetes 2025; 17: e70082
• 11 Lemos JA de, Linetzky B, Le Roux CW. et al. Tirzepatide Reduces 24-Hour Ambulatory Blood Pressure in Adults With Body Mass Index ≥ 27 kg/m2: SURMOUNT-1 Ambulatory Blood Pressure Monitoring Substudy. Hypertension 2024; 81: e41-43
• 12 Kennedy C, Hayes P, Cicero AFG. et al. Semaglutide and blood pressure: an individual patient data meta-analysis. Eur Heart J 2024; 45: 4124-4134
• 13 Malhotra A, Grunstein RR, Fietze I. et al. Tirzepatide for the Treatment of Obstructive Sleep Apnea and Obesity. N Engl J Med 2024; 391: 1193-1205
• 14 Lin R, Yan W, He M. et al. The benefits of hypoglycemic therapy for patients with obstructive sleep apnea. Sleep Breath 2024; 28: 1355-1363
• 15 Rieg T, Gerasimova M, Murray F. et al. Natriuretic effect by exendin-4, but not the DPP-4 inhibitor alogliptin, is mediated via the GLP-1 receptor and preserved in obese type 2 diabetic mice. Am J Physiol Renal Physiol 2012; 303: F963-971
• 16 Ribeiro-Silva JC, Tavares CAM, Girardi ACC. The blood pressure lowering effects of glucagon-like peptide-1 receptor agonists: A mini-review of the potential mechanisms. Curr Opin Pharmacol 2023; 69: 102355
• 17 Avogaro A, Vigili de Kreutzenberg S, Fadini GP. Cardiovascular actions of GLP-1 and incretin-based pharmacotherapy. Curr Diab Rep 2014; 14: 483
• 18 Schiavon CA, Bersch-Ferreira AC, Santucci EV. et al. Effects of Bariatric Surgery in Obese Patients With Hypertension: The GATEWAY Randomized Trial (Gastric Bypass to Treat Obese Patients With Steady Hypertension). Circulation 2018; 137: 1132-1142
• 19 Hall ME, Cohen JB, Ard JD. et al. Weight-Loss Strategies for Prevention and Treatment of Hypertension: A Scientific Statement From the American Heart Association. Hypertension 2021; 78: e38-e50
• 20 Mavrakanas TA, Tsoukas MA, Brophy JM. et al. SGLT-2 inhibitors improve cardiovascular and renal outcomes in patients with CKD: a systematic review and meta-analysis. Sci Rep 2023; 13: 15922
• 21 Carvalho PEP, Veiga TMA, Simões E Silva AC. et al. Cardiovascular and renal effects of SGLT2 inhibitor initiation in acute heart failure: a meta-analysis of randomized controlled trials. Clin Res Cardiol 2023; 112: 1044-1055
• 22 Ostrominski JW, Vaduganathan M, Selvaraj S. et al. Dapagliflozin and Apparent Treatment-Resistant Hypertension in Heart Failure With Mildly Reduced or Preserved Ejection Fraction: The DELIVER Trial. Circulation 2023; 148: 1945-1957
• 23 Ye N, Jardine MJ, Oshima M. et al. Blood Pressure Effects of Canagliflozin and Clinical Outcomes in Type 2 Diabetes and Chronic Kidney Disease: Insights From the CREDENCE Trial. Circulation 2021; 143: 1735-1749
• 24 Cai Y, Shi W, Xu G. The efficacy and safety of SGLT2 inhibitors combined with ACEI/ARBs in the treatment of type 2 diabetes mellitus: A meta-analysis of randomized controlled studies. Expert Opin Drug Saf 2020; 19: 1497-1504
• 25 Weber MA, Mansfield TA, Cain VA. et al. Blood pressure and glycaemic effects of dapagliflozin versus placebo in patients with type 2 diabetes on combination antihypertensive therapy: a randomised, double-blind, placebo-controlled, phase 3 study. Lancet Diabetes Endocrinol 2016; 4: 211-220
• 26 Wan N, Rahman A, Hitomi H. et al. The Effects of Sodium-Glucose Cotransporter 2 Inhibitors on Sympathetic Nervous Activity. Front Endocrinol (Lausanne) 2018; 9: 421
• 27 Neuen BL, Heerspink HJL, Vart P. et al. Estimated Lifetime Cardiovascular, Kidney, and Mortality Benefits of Combination Treatment With SGLT2 Inhibitors, GLP-1 Receptor Agonists, and Nonsteroidal MRA Compared With Conventional Care in Patients With Type 2 Diabetes and Albuminuria. Circulation 2024; 149: 450-462
• 28 Castellana M, Cignarelli A, Brescia F. et al. Efficacy and safety of GLP-1 receptor agonists as add-on to SGLT2 inhibitors in type 2 diabetes mellitus: A meta-analysis. Sci Rep 2019; 9: 19351