Current Vascular Pharmacology - Online First

Among the organ damage mediated by hypertension, cardiac lesions hold significant importance. Numerous authors focus on hypertensive heart disease (HHD) rather than exclusively on left ventricular hypertrophy (LVH).

This narrative review aims to assess the incorporation of the concept of 'hypertensive heart disease' (HHD) in hypertension (HTN) guidelines. Furthermore, if HHD is not addressed, the review will evaluate the potential benefits of including this concept in future studies.

The following databases were searched: Scopus, Medline, Springer, Science Direct, Wiley, SAGE, Cambridge, Oxford Journals, and Google Scholar. Attention was given to the guidelines related to hypertension(HTN); the search items were “guidelines” and “hypertension.” Within these guidelines, we specifically sought references to ‘hypertensive heart disease.’.

The concept of “HHD” is clearly advantageous compared to “HTN LVH,” as it not only addresses LVH but also considers other structures of the heart that may be severely affected, which can significantly influence treatment. The concept of “hypertensive heart disease” is mentioned in only 8 out of 36 guidelines on HTN. The therapeutic implications and recommendations are absent in the guidelines.

The concept of HHD is reasonable and evidence-based, and there is no reason to focus only on LVH when considering HTN-induced damage to the heart. It is time to update our recommendations for heart treatment by using the phrase “Treatment of hypertensive heart disease” instead of “Treatment of hypertensive LVH.” This update can enhance our awareness of the need to improve not only HTN LVH but the other parts of the heart as well.

Sodium Glucose cotransporter-2 inhibitors (SGLT2is) possess pleiotropic effects, such as antioxidant, antifibrotic, anti-inflammatory, and vascular remodeling activities. Considering the lack of literature, a network meta-analysis was conducted to explore the impact of SGLT2is on endothelial dysfunction and arterial stiffness in the diabetic population.

Electronic databases were searched to identify randomized clinical trials evaluating the effects of SGLT2is on outcomes, such as Flow-mediated Vasodilation (FMV), Pulse Wave Velocity (PWV), and Augmentation Index (AIx). Direct, indirect, and mixed treatment comparisons generated pooled estimates using random-effects modeling. Effect sizes were reported as Hedges' g with 95% Confidence Interval (95% CI). Bootstrap and permutation meta-analyses were performed using ranking plots. The certainty of evidence was graded.

Twelve low risk of bias articles (706 participants) were included. SGLT2is were associated with significant improvements in FMV (g: 0.48; 95% CI: 0.08, 0.88), confirmed by bootstrap meta-analysis (g: 0.48; 95% CI: 0.1, 0.85) and permutation meta-analysis of FMD (g: 0.48; 95% CI: 0.05, 0.9). Within SGLT2is, dapagliflozin (g: 0.39; 95% CI: 0.14, 0.65) and empagliflozin (g: 0.66; 95% CI: -0.65, 1.97) significantly improved FMV, and dapagliflozin (g: -0.61, 95% CI: -0.98, -0.24) and tofogliflozin (g: -3.51; 95% CI: -4.05, -2.98) significantly improved PWV. A low risk of publication bias was observed, and the ranking plots revealed dapagliflozin to have the best probability (0.99) of being the most effective for improving FMV. Low certainty of evidence was observed for all outcomes.

SGLT2 inhibitors improve endothelial function and arterial stiffness in the diabetic population. Clinical studies evaluating the association between improvements in endothelial function with SGLT2is and reduced adverse cardiovascular and cardiorenal events and mortality are urgently needed.