Sodium-Glucose Cotransporter 2 Inhibitors and Pulmonary Hypertension: A Systematic Review

Abstract

Pulmonary hypertension (PH) is a chronic disease characterized by elevated pulmonary arterial pressure, often leading to right ventricular failure. Sodium-glucose cotransporter 2 (SGLT2) inhibitors are potential therapies for PH due to their cardiovascular effects. In this systematic review, we aim to assess the safety and efficacy of SGLT2 inhibitors in improving pulmonary hemodynamics and cardiac parameters in patients with PH. A systematic review search until November 2024 was conducted across 8 databases. Six studies involving 462 participants were included, comprising 3 randomized controlled trials, 2 observational studies, and 1 cohort study. SGLT2 inhibitors, particularly dapagliflozin and empagliflozin, significantly reduced pulmonary arterial pressure in most studies. Cardiac indices, such as left ventricular diastolic and systolic diameters, E/e', and left ventricular ejection fraction, also improved. However, one randomized controlled trial reported no significant improvement in the hemodynamic outcomes. SGLT2 inhibitors are assumed to be promising in the management of PH through cardiac and hemodynamic improvements. Further research is needed to elucidate their efficacy and the underlying mechanisms.