INTRODUCTION: Large-scale clinical trials have reported that, in patients with type 2 diabetes mellitus (T2DM), sodium-glucose cotransporter 2 (SGLT2) inhibitor treatment affords favorable renal outcomes; the underlying mechanisms, however, remain unclear. Thus, this study investigated how SGLT2 inhibitor-induced changes in the mean arterial pressure (MAP; denoted as ΔMAP) are associated with the renal outcomes in T2DM patients with chronic kidney disease (CKD). MATERIALS AND METHODS: We retrospectively assessed the data of 624 Japanese T2DM patients with CKD who had been using SGLT2 inhibitors for >1 year. For propensity score matching (1:1 nearest neighbor match, with caliper value=0.053, no replacement), patients were categorized into two groups based on the ΔMAP (>-4 mmHg [n=329] and ≤-4.0 mmHg [n=295]). Composite albuminuria progression or a ≥15% annual reduction in the estimated glomerular filtration rate (eGFR) was regarded as the endpoint. RESULTS: Per group, 173 propensity-matched patients were compared. Patients with ΔMAP ≤-4 mmHg had a significantly lower incidence of composite renal outcomes than those with ΔMAP ≥-4 mmHg (5.8% [n=10] vs. 15.6% [n=27], p=0.003). Although the between-group differences in the eGFRs were nonsignificant, patients with a ΔMAP ≤-4 mmHg had significantly larger reductions in the logarithmic urine albumin-to-creatinine ratio (p=0.005). CONCLUSIONS: The degree of BP reduction after SGLT2 inhibitor treatment influenced renal composite outcomes in Japanese T2DM patients with CKD, confirming the importance of blood pressure management in T2DM patients with CKD, even when they are under SGLT2 inhibitor treatment.