Comment on “Renal and cardiovascular effects of SGLT2 inhibitors among hypertensive patients with chronic kidney disease: A systematic review and meta-analysis”

Comment on "Renal and cardiovascular effects of SGLT2 inhibitors among hypertensive patients with chronic kidney disease: A systematic review and meta-analysis" Dear Editor,We read with interest this systematic review and meta-analysis evaluating SGLT2 inhibitors in hypertensive chronic kidney disease [1].The study addresses an important clinical question and reports reduced risks of renal progression, cardiovascular events, and serious adverse events, supporting broader cardiorenal use in this high-risk population.A key methodological issue concerns search transparency and reproducibility.Although multiple databases were reportedly searched, the study flow numerically accounts only for PubMed and ClinicalTrials.gov, which makes the complete search difficult to verify.In addition, the pooled "hypertensive" subgroup appears clinically heterogeneous, combining blood pressure based definitions with trial-defined hypertension or antihypertensive treatment.This matters because contemporary evidence suggests that SGLT2 benefits vary in absolute magnitude according to baseline CKD risk, albuminuria, and diabetes status [1,2].A related concern is subgroup interpretation.Recent evidence from the same journal indicates that SGLT2 inhibitors produce only modest blood pressure reductions, suggesting that the observed renal benefit may not map cleanly onto a hypertension-defined subgroup alone [3].Clarification of denominator discrepancies, subgroup ascertainment, and presentation of absolute risk differences would therefore strengthen interpretation, especially because large contemporary meta-analyses show broad renal benefit across eGFR, albuminuria, and diabetes strata [4,5].Addressing these points would improve interpretability and help clinicians apply these findings more precisely in practice.