Does Jardiance lower blood pressure?

In this article:

• Jardiance and blood pressure
• Clinical evidence
• How does Jardiance lower blood pressure?
• Who benefits most from Jardiance?
• Combining Jardiance with hypertension meds

In this article

• Jardiance and blood pressure
• Clinical evidence
• How does Jardiance lower blood pressure?
• Who benefits most from Jardiance?
• Combining Jardiance with hypertension meds

If you’re living with Type 2 diabetes, you may also be experiencing high blood pressure. In fact, people with diabetes are twice as likely to have high blood pressure, and approximately two-thirds of people with diabetes use medication for hypertension.

Jardiance (empagliflozin) is a prescription drug that is FDA approved to treat people with Type 2 diabetes, heart failure, and chronic kidney disease. It is not intended to treat Type 1 diabetes. The medication primarily lowers blood sugar, though it also results in lowered blood pressure as well as other improved biomarkers.

Can Jardiance lower blood pressure?

“Jardiance indirectly lowers blood pressure,” says Erika Gray, Pharm.D., founder and chief medical officer at ToolBox Genomics.com. Jardiance is not a blood pressure medication, but it has the side effect of lowering those numbers.

Diabetes and hypertension (persistently elevated blood pressure) have reciprocal causation; that is, the presence of one can lead to the existence of the other. Insulin resistance associated with diabetes has been shown to predispose people to hypertension, and the arterial stiffness associated with hypertension has been shown to worsen insulin resistance.

Jardiance is effective at both lowering blood sugar levels and reducing blood pressure. 

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Clinical evidence for the effect of Jardiance on blood pressure

“Hypertension is very common as people age—about 50% to 60% of adults over 55 develop it,” says Steven Lamm, MD, medical director at Preston Robert Tisch Center for Men’s Health at New York University Langone Health. 

If you have Type 2 diabetes, you already know how important it is to control your blood sugar and weight. Jardiance’s effect on blood pressure can be life-changing for people who have hypertension and Type 2 diabetes, as well as those diagnosed with heart failure. The drug reduces the risk of heart disease, heart attacks, and cardiovascular deaths.

One notable clinical trial examined the results of people who were taking empagliflozin for either 12 or 24 weeks. In both cases, participants experienced a decrease in diastolic and systolic blood pressure readings. Other factors also saw favorable outcomes, including reductions in pulse pressure, arterial pressure, and ambulatory arterial stiffness index (a measure of hardened arteries).

In another clinical trial, participants received either 10 or 25 milligrams of empagliflozin or a placebo once daily for 12 weeks. People in the empagliflozin groups experienced reductions in blood pressure, lost weight, and had a decrease in blood glucose levels.

A number of factors influence just how effective or safe Jardiance may be for you: 

• Renal function: Jardiance is contraindicated for those with severe kidney impairment because the drug depends on proper kidney function to filter glucose.   
• Baseline blood pressure: Studies show that people with higher baseline blood pressure numbers experience more significant reductions in those readings compared to those with lower blood pressure.
• Concomitant medications: Combining Jardiance with other blood pressure medications is common, though it could result in dehydration or hypotension (low blood pressure).
  Fluid levels: If you are not well-hydrated, Jardiance may not be effective, and you may experience severe dehydration as the medication works to remove fluids from your body.
• Age: The manufacturer of Jardiance, Boehringer Ingelheim, states that geriatric patients may be at an increased risk of volume depletion and renal impairment as a side effect of the drug, and therefore may not fully benefit from the medication.

If any of these concerns apply to you, consult your healthcare provider before starting Jardiance.

How does Jardiance lower blood pressure?

Jardiance is in a class of drugs known as sodium-glucose cotransporter-2 inhibitors, or SGLT2 inhibitors. These block SGLT2s, which reabsorb glucose and sodium into the kidneys. SGLT2 inhibitors, such as empagliflozin and dapagliflozin, prevent glucose and sodium from going back into your bloodstream.

“Jardiance decreases the amount of salt our body absorbs, which is removed from the body through urine,” explains Dr. Erika Gray. “Water in the body will follow where salt goes, so water will also leave the body through urine, which will help lower blood pressure.”

A small study found that patients experienced antihypertensive effects within just a few months of starting empagliflozin, though it could be up to six months or longer before the full effects of the medication take place.

Sodium excretion 

A study involving 20 patients with Type 2 diabetes found that taking empagliflozin resulted in an increase in sodium excretion and a reduction in blood volume. This mimics a natural process in which your kidneys respond to elevated blood pressure by excreting sodium and water. When there is a lowered blood volume, and therefore a decrease of the total fluid in your body, there is less pressure on your blood vessels and a lower workload on your heart. 

Osmotic diureses

Jardiance is not a traditional diuretic, but it does have a diuretic effect. This means that it increases urination. Jardiance works by blocking sodium from re-entering your bloodstream by inhibiting SGLT2s, which causes more glucose to be excreted in your urine. This is known as glycosuria, one of the side effects of which is increased urination. 

The more you go to the bathroom, the more you eliminate salt and water from your body. This lowered volume of fluid leads to less stress on your heart and lower blood pressure.

Improved vascular function

There are two other ways Jardiance may improve your blood vessel function. The first is that the lowered blood volume the drug creates means less stress on your vascular system.

The second is that Jardiance may improve the condition of your blood vessels. In a clinical trial, 58 people with Type 2 diabetes took empagliflozin once daily for six weeks and experienced a decrease in arterial stiffness. This means blood vessels are more responsive and flexible, which can result in lowered blood pressure. 

RAAS modulation

When Jardiance blocks SGLT2s, one of the effects is the activation of the renin-angiotensin-aldosterone system (RAAS), which balances your blood pressure. If you have high blood pressure, your RAAS becomes overactive, which actually makes your condition worse. 

As an SGLT2 inhibitor, Jardiance affects the RAAS inside your kidneys. There, it works to reduce pressure inside the organ itself, suppress the release of renin (an enzyme that increases blood pressure), and modulate your RAAS to restore its normal function. This results in improved blood pressure regulation and thus a healthier cardiovascular system.

Weight loss

Losing weight reduces blood pressure in a few ways: it improves the way your blood vessels function, it reduces the workload on your heart, and it lowers inflammation.

Weight loss is a side effect of Jardiance because it removes glucose, a simple sugar, from your blood. To be clear, this isn’t a weight loss medication; however, there are people who experience weight loss after taking Jardiance. In a study of 3,300 people with Type 2 diabetes, those who took empagliflozin for either 12 or 24 weeks lost weight, lowered their body fat, and noticed a difference in their waist circumference. 

Who benefits most from Jardiance’s blood pressure-lowering effects?

“Jardiance can benefit anyone who is at particular risk for cardiovascular disease,” says Dr. Steven Lamm. 

He notes that the following people stand to gain the most from the effects of the drug:

• People with hypertension or obesity
• Those who have high cholesterol
• Patients with coronary disease
• Those with a strong family history of these conditions

“Jardiance lowers blood pressure and decreases the amount of fluid being retained in the body,” adds Dr. Erika Gray. “This puts less strain on the heart, which is beneficial for patients with heart failure.”

A double-blind trial of nearly 6,000 people with heart failure found that empagliflozin is effective in reducing hospitalizations and deaths related to their cardiovascular disease, regardless of whether the person has Type 2 diabetes or not.

Combining Jardiance with other blood pressure medications

Jardiance has a side effect of lowering blood pressure. It behaves differently from other typical hypertensive drugs and has few drug-drug interactions. Therefore, your healthcare provider may recommend combining Jardiance with another medication.

“When prescribing blood pressure medications, doctors are trying to get the patient’s systolic blood pressure to 130 or less, especially in diabetics, to preserve their kidney function and reduce heart failure,” says Dr. Lamm. “It’s very uncommon to be able to achieve that with one drug, so we often combine drugs.” 

The following types of drugs may be used in combination with Jardiance, though there may be some side effects:

• Diuretics (water pills): Combining drugs like furosemide or hydrochlorothiazide with Jardiance could lead to dehydration and low blood pressure.
• Nitrates: If you use a drug like nitroglycerin while on Jardiance, you could experience a sharp drop in blood pressure, leading to fainting, dizziness, lightheadedness, or even a more serious event.
• Angiotensin receptor blockers (ARBs): Though generally considered safe, combining ARBs and Jardiance could potentially put you at risk for kidney issues and hyperkalemia.
• Angiotensin-converting enzyme (ACE) inhibitors: Many people take both ACE inhibitors and Jardiance; however, there is potential for the combination to adversely affect the kidneys.
  

Jardiance is often combined with Type 2 diabetes drugs like metformin, insulin, and sulfonylureas. While this is considered safe for most people, it could lead to hypoglycemia (low blood sugar). 

Before taking brand-name or over-the-counter drugs with even just one dose of Jardiance, get medical advice from a healthcare professional. Even the most seemingly benign drugs or supplements could interact with each other, causing serious and even life-threatening consequences.

Jardiance side effects

Get to know the potential and even serious side effects of a drug before you take it. There are a few common side effects of Jardiance, ranging from mild to severe. These include urinary tract infections, allergic reactions, an increase in LDL cholesterol, genital yeast infections, diabetic ketoacidosis (very high blood sugar), and rarely a life-threatening condition called Fournier’s gangrene.