Abstract Body: ntroduction:
SGLT-2 inhibitors are widely used in patients with diabetes and heart failure (HF), with known antihypertensive effects. However, their role in managing hypertension (HTN) in patients without diabetes or HF remains unclear.
Methods:
This retrospective cohort study used the TriNetX Global Network to identify adults (≥18 years) with HTN but without diabetes or HF from Jan 2020 to May 2025. Two propensity-matched cohorts (n=661,378 each) were compared: Cohort 1 received SGLT-2 inhibitors; Cohort 2 did not. Matching included demographics, comorbidities, and medications. Mean age was 64 years; 55% were male. Mean follow-up was 629 days for Cohort 1 and 581 days for Cohort 2. The primary aim was to evaluate the association between SGLT-2 inhibitor use and all-cause mortality, cardiovascular, and renal outcomes.
Results:
All-cause mortality was lower in Cohort 1 (3.62%) vs. Cohort 2 (5.23%) [RR: 0.691; HR: 0.638; p<0.0001]. However, HF risk was higher in Cohort 1 (12.31%) vs. Cohort 2 (9.47%) [RR: 1.30; HR: 1.246; p<0.0001]. AMI incidence was also greater (4.33% vs. 3.70%) [RR: 1.17; HR: 1.094; p<0.0001]. Atrial fibrillation/flutter was slightly more common but better survival in cohort one compared to cohort 2 (11.66% vs. 11.16%) [RR: 1.045; HR: 0.973; p<0.0001]. Hypertensive emergency occurred less often in Cohort 1 (1.02% vs. 1.52%) [RR: 0.667; HR: 0.619; p=0.115]. Risk of acute kidney injury or CKD was higher in Cohort 1 (24.21%) vs. Cohort 2 (16.00%) [RR: 1.513; HR: 1.470; p<0.0001]. Cerebral infarction rates were similar (4.47% vs. 4.41%) [RR: 1.013; HR: 0.942; p=0.143].
Conclusion:
Among hypertensive patients without diabetes or HF, SGLT-2 inhibitor use was associated with reduced all-cause mortality and fewer hypertensive emergencies, but increased risks of HF, AMI, and kidney disease. These findings highlight the need for cautious, individualized use of SGLT-2 inhibitors in this population.