From the Guidelines
Farxiga (dapagliflozin) does not typically increase blood pressure; in fact, it often has the opposite effect and may slightly lower blood pressure. This is due to its mechanism as an SGLT2 inhibitor, which helps the kidneys remove excess sugar from the bloodstream through urine, causing increased urination and sodium excretion, leading to a mild diuretic effect and subsequent reduction in blood pressure. The most recent and highest quality study, 1, discusses the effects of SGLT2 inhibitors, including dapagliflozin, on cardiovascular outcomes, but does not specifically address the effect on blood pressure. However, another study, 1, mentions the results of the DECLARE-TIMI 58 trial, which assessed the effects of dapagliflozin on cardiovascular and renal outcomes, and although it does not directly address blood pressure, it is known that SGLT2 inhibitors like dapagliflozin can cause modest reductions in systolic blood pressure. Some key points to consider when prescribing Farxiga include:
- Monitoring blood pressure in patients who are already on blood pressure medications, as their healthcare provider might need to adjust their antihypertensive medications
- Being aware of the potential for symptoms of low blood pressure, such as dizziness, especially when starting the medication or in patients taking other blood pressure medications
- Understanding the benefits of the blood pressure-lowering effect of Farxiga for many patients with type 2 diabetes who also have hypertension.
From the FDA Drug Label
Dapagliflozin also reduces sodium reabsorption and increases the delivery of sodium to the distal tubule. This may influence several physiological functions including, but not restricted to, lowering both pre- and afterload of the heart and downregulation of sympathetic activity, and decreased intraglomerular pressure which is believed to be mediated by increased tubuloglomerular feedback.
The FDA drug label does not directly answer whether Farxiga (dapagliflozin) increases blood pressure. However, it does mention that dapagliflozin may influence physiological functions that could affect blood pressure, such as lowering pre- and afterload of the heart and downregulation of sympathetic activity. In patients ≥65 years of age, a higher proportion of patients treated with dapagliflozin for glycemic control had adverse reactions of hypotension 2. Therefore, based on the available information, it can be inferred that Farxiga (dapagliflozin) is more likely to decrease blood pressure rather than increase it.
From the Research
Effects of Farxiga (Dapagliflozin) on Blood Pressure
- Dapagliflozin has been shown to reduce blood pressure in numerous clinical studies 3, 4.
- The mechanism of action of dapagliflozin, which involves the inhibition of sodium-glucose cotransporter-2, leads to increased urinary glucose excretion and reduced blood glucose levels, and also has a diuretic effect that can contribute to reduced blood pressure 5, 6.
- Clinical trials have demonstrated that dapagliflozin can reduce blood pressure fluctuations and contribute to stable sodium diuresis, potentially lowering cardiovascular disease risks 4.
- The reduction in blood pressure is considered one of the beneficial effects of dapagliflozin, in addition to its glucose-lowering and weight-reducing properties 3, 7.
Key Findings
- Dapagliflozin has been found to be effective in reducing blood pressure in patients with type 2 diabetes and those with heart failure with reduced ejection fraction 3, 7.
- The blood pressure-lowering effect of dapagliflozin is maintained over longer-term follow-up periods 5.
- Dapagliflozin is generally well-tolerated, with a low risk of hypoglycemia and a favorable safety profile 3, 4, 7, 5, 6.