Jardiance for High Blood Pressure and High Cholesterol
Jardiance (empagliflozin) is effective for lowering blood pressure but is NOT a treatment for high cholesterol—you must use statins for cholesterol management.
Blood Pressure Effects
Jardiance provides meaningful blood pressure reduction as an added benefit to its glucose-lowering effects:
Empagliflozin reduces systolic blood pressure by approximately 4 mmHg and diastolic blood pressure by approximately 2 mmHg through osmotic diuresis and calorie loss 1.
In the EMPA-REG BP trial, empagliflozin 10 mg and 25 mg reduced 24-hour mean systolic/diastolic blood pressure by 3-5/2-3 mmHg compared to placebo over 12 weeks 2.
This blood pressure reduction occurs regardless of how many other antihypertensive medications the patient is taking (0,1, or ≥2 medications), and works independently of whether patients are on diuretics or ACE inhibitors/ARBs 2.
The blood pressure-lowering effect is consistent across different populations, including Black/African American patients with type 2 diabetes and hypertension 3.
Important Context
However, Jardiance is not a first-line antihypertensive agent. For patients with diabetes and hypertension:
The primary treatment strategy should include a RAS inhibitor (ACE inhibitor or ARB) combined with a calcium channel blocker and/or thiazide-like diuretic 4.
Blood pressure should be lowered to a target of <130/80 mmHg in patients with diabetes 4.
Jardiance can be added to standard antihypertensive therapy for its cardiovascular benefits and additional blood pressure reduction 2.
Cholesterol Management
Jardiance has NO direct effect on cholesterol levels and should NOT be used to treat hyperlipidemia.
For cholesterol management in patients with diabetes:
Statins are the lipid-lowering treatment of choice, with or without ezetimibe and/or PCSK9 inhibitors 4.
LDL-cholesterol should be reduced to <70 mg/dL (1.8 mmol/L) in patients with diabetes and target organ damage, or <100 mg/dL (2.6 mmol/L) in uncomplicated diabetes 4.
Triglyceride lowering should be considered if levels exceed 200 mg/dL (2.3 mmol/L), particularly in patients with hypertension and diabetes, using fenofibrate 4.
Cardiovascular Benefits
The real value of Jardiance lies in its proven cardiovascular protection:
In the EMPA-REG OUTCOME trial, empagliflozin reduced cardiovascular death by 38% and the composite outcome of MI, stroke, and cardiovascular death by 14% in patients with type 2 diabetes and established cardiovascular disease 4.
Empagliflozin is now approved for symptomatic chronic heart failure across the full spectrum of ejection fractions, regardless of diabetes status 5.
Clinical Algorithm
For a patient with diabetes, hypertension, and hyperlipidemia:
Start a statin immediately for cholesterol management (target LDL-C <70-100 mg/dL depending on risk) 4.
Initiate RAS inhibitor (ACE-I or ARB) plus calcium channel blocker or thiazide diuretic for blood pressure control (target <130/80 mmHg) 4, 6.
Add Jardiance (empagliflozin 10-25 mg daily) for glucose control, cardiovascular protection, and additional blood pressure reduction 4, 1.
Monitor for genital mycotic infections (more common in women) and volume depletion, especially in elderly or at-risk patients 1.
Common Pitfalls
Do not use Jardiance as monotherapy for hypertension—it provides modest blood pressure reduction but is not a substitute for standard antihypertensive therapy 2.
Do not expect any cholesterol-lowering effect from Jardiance—always prescribe a statin separately for lipid management 4.
Avoid in patients with significant renal insufficiency—the efficacy of empagliflozin decreases with declining kidney function 1.
Do not combine two RAS blockers (ACE inhibitor + ARB) as this increases adverse effects without additional benefit 6.