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Phytomedicine : International Journal... Dec 2022Hypertension is one of the most significant public health challenges worldwide. An increasing number of patients prefer to incorporate traditional Chinese medicine into... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Hypertension is one of the most significant public health challenges worldwide. An increasing number of patients prefer to incorporate traditional Chinese medicine into their hypertensive care. The Songling Xuemaikang capsule (SXC), a Chinese herbal formula, is widely used in China for essential hypertension.
PURPOSE
To assess the efficacy and safety of SXC for essential hypertension.
STUDY DESIGN
Systematic review and meta-analysis of randomized controlled trials (RCTs).
METHODS
We conducted a systematic literature search of seven databases to identify randomized controlled trials of SXC for hypertension. The outcome measures included blood pressure parameters and patient-reported outcomes. Potential heterogeneity between the studies was resolved by subgroup and sensitivity analyses. The quality of the results was evaluated using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach.
RESULTS
A total of 34 trials with 4306 patients were included. The results showed that SXC plus antihypertensive drugs produced a greater effect on reducing systolic blood pressure (SBP) (MD: -7.54 mmHg; 95% CI: -8.92, -6.17; p < 0.00001), diastolic blood pressure (DBP) (MD: -6.42 mmHg; 95% CI: -7.54, -5.29; p < 0.00001), 24-hour SBP (MD: -6.88 mmHg; 95% CI: -8.36, -5.39; p < 0.00001), and 24-hour DBP (MD: -4.31 mmHg; 95% CI: -6.55, -2.07; p = 0.0002) and improving hypertensive symptoms (SMD: -1.09; 95% CI: -1.34, -0.84; p < 0.00001) than antihypertensive drugs alone. SXC monotherapy was less effective than antihypertensive drugs for 24-hour SBP reduction (MD: 2.07 mmHg; 95% CI: 0.19, 3.96; p = 0.03). No significant difference was observed in the incidence of adverse events between the SXC and control groups.
CONCLUSION
SXC is beneficial for essential hypertension; it can lower BP, improve hypertensive symptoms and is well tolerated.
Topics: Antihypertensive Agents; Blood Pressure; Drugs, Chinese Herbal; Essential Hypertension; Humans; Hypertension; Randomized Controlled Trials as Topic
PubMed: 36183476
DOI: 10.1016/j.phymed.2022.154459 -
PloS One 2023Targeting blood pressure variability (BPV) can potentially reduce cardiovascular events and incidence of mortality, but whether exercise reduces BPV remains... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND AIMS
Targeting blood pressure variability (BPV) can potentially reduce cardiovascular events and incidence of mortality, but whether exercise reduces BPV remains controversial. This systematic review and meta-analysis were designed to study the impact of an exercise intervention on BPV in adults.
METHODS
A systematic search of PubMed, Web of Science, Scopus, EBSCO host, Cochrane, Embase, Science direct databases was done to retrieve controlled trials published from inception to January 10, 2023 that investigated the effects of exercise on BPV. The main characteristics of each study were synthesized, re-evaluated, and used in this meta-analysis.
RESULTS
Eleven studies with 514 adults with exercise training were eligible for single-arm meta-analysis and six randomized controlled trials (RCTs) were selected for further meta-analysis. After exercise training, systolic blood pressure variability (SBPV) (effect size = -0.76, 95%CI: -1.21 to -0.30, I2 60%), especially the average real variability SBP (-0.85, -1.44 to -0.27, I2 59%), was significantly improved. SBPV (-0.68, -1.18 to -0.18, I2 64%) significantly improved in hypertension patients. Aerobic exercise improved SBPV (-0.66, -1.32 to -0.00, I2 45%), and combined training improved both SBPV (-0.74, -1.35 to -0.14, I2 65%) and diastolic blood pressure variability (DBPV) (-0.36, -0.65 to -0.02, I2 33%). The SBPV of daytime (-0.90, -1.39 to -0.40, I2 57%) and DBPV of daytime (-0.31, -0.53 to -0.08, I2 0%) values demonstrated significant improvement compared to the night-time values. Moreover, six RCTs demonstrated a decrease in SBPV (-1.03, -1.77 to -0.28, I2 45%).
CONCLUSION
This study provides quantitative evidence that exercise training can improve BPV, especially SBPV, in adults. This meta-analysis suggests that aerobic exercise and combined training should be recommended for hypertension patients.
Topics: Humans; Adult; Blood Pressure; Hypertension; Exercise
PubMed: 37851627
DOI: 10.1371/journal.pone.0292020 -
JMIR MHealth and UHealth Aug 2023Mobile health (mHealth) interventions are effective in improving chronic disease management, mainly in high-income countries. However, less is known about the efficacy... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Mobile health (mHealth) interventions are effective in improving chronic disease management, mainly in high-income countries. However, less is known about the efficacy of mHealth interventions for the reduction of cardiovascular risk factors, including for hypertension and diabetes, which are rapidly increasing in low- and middle-income countries.
OBJECTIVE
This study aimed to assess the efficacy of mHealth interventions for diabetes and hypertension management in Africa.
METHODS
We searched PubMed, Cochrane Library, Google Scholar, African Journals Online, and Web of Science for relevant studies published from inception to July 2022. The main outcomes of interest were changes in hemoglobin A1c (HbA1c), systolic blood pressure, and diastolic blood pressure. The random or fixed effect model was used for the meta-analysis, and the I2 statistic was used to gauge study heterogeneity. Z tests and P values were used to evaluate the effect of mHealth interventions on HbA1c and blood pressure levels.
RESULTS
This review included 7 studies (randomized controlled trials) with a total of 2249 participants. Two studies assessed the effect of mHealth on glycemic control, and 5 studies assessed the effect of mHealth on blood pressure control. The use of mHealth interventions was not associated with significant reductions in HbA1c levels (weighted mean difference [WMD] 0.20, 95% CI -0.40 to 0.80; P=.51) among patients with diabetes and systolic blood pressure (WMD -1.39, 95% CI -4.46 to 1.68; P=.37) and diastolic blood pressure (WMD 0.36, 95% CI -1.37 to 2.05; P=.69) among patients with hypertension. After conducting sensitivity analyses using the leave-one-out method, the Kingue et al study had an impact on the intervention, resulting in a 2 mm Hg reduction in systolic blood pressure (WMD -2.22, 95% CI -3.94 to -0.60; P=.01) but was nonsignificant for diastolic blood pressure and HbA1c levels after omitting the study.
CONCLUSIONS
Our review provided no conclusive evidence for the effectiveness of mHealth interventions in reducing blood pressure and glycemic control in Africa among persons with diabetes and hypertension. To confirm these findings, larger randomized controlled trials are required.
Topics: Humans; Glycated Hemoglobin; Hypertension; Blood Pressure; Diabetes Mellitus; Africa
PubMed: 37646291
DOI: 10.2196/43742 -
PloS One 2022Excessive salt intake results in hypertension (HTN), which is a major risk factor for cardiovascular disease (CVD). This review and meta-analysis aimed to evaluate the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Excessive salt intake results in hypertension (HTN), which is a major risk factor for cardiovascular disease (CVD). This review and meta-analysis aimed to evaluate the effect of salt reduction interventions on systolic blood pressure (SBP) and diastolic blood pressure (DBP).
METHODS
Studies were identified via systematic searches of the databases, including PubMed, Embase, Scopus, and Web of Science. All the studies examining the effectiveness of salt reduction interventions on blood pressure (BP), regardless of age, sex, and HTN status, were included in the systematic review, and eligible studies were used in the meta-analysis. A random-effect model was applied for quantitative data synthesis.
RESULTS
A total of 50 trials extracted from 40 articles (21 trials on nutrition education,10 on self-help materials,17 on salt substitutes, and 2 on food reformulation) were included in the systematic review. The pooled results of 44 eligible trials showed that salt substitution and nutrition education interventions had significant effects on both SBP (WMD: -7.44 mmHg, P<0.001 and WMD: -2.75 mmHg, P<0.001, respectively), and DBP (WMD: -3.77 mmHg, P<0.001 and WMD: -2.11 mmHg, P<0.001, respectively). Furthermore, using self-help materials led to a significant reduction in SBP among subjects aged 25-60 years (WMD: -2.60 mmHg, P = 0.008); it also decreased both SBP and DBP among those who were hypertensive (WMD: -3.87 mmHg, P = 0.003 and WMD: -2.91 mmHg, P<0.001, respectively).
CONCLUSION
Our results supported that salt substitution and nutrition education are effective nutrition strategies to lower BP. It seems that multi-component approaches could be more effective in improving BP status. However, further trials are required.
Topics: Humans; Sodium Chloride, Dietary; Blood Pressure; Health Education
PubMed: 36477548
DOI: 10.1371/journal.pone.0277929 -
The American Journal of Clinical... May 2017High blood pressure is a strong risk factor for cardiovascular disease. The aim of this study was to determine the associations of dietary glycemic index (GI) and... (Meta-Analysis)
Meta-Analysis Review
High blood pressure is a strong risk factor for cardiovascular disease. The aim of this study was to determine the associations of dietary glycemic index (GI) and glycemic load (GL) with systolic blood pressure (SBP) and diastolic blood pressure (DBP) in healthy individuals. A systematic review and meta-analysis of randomized controlled trials (RCTs) was carried out. Databases were searched for eligible RCTs in 2 phases. MEDLINE, Embase, CAB Abstracts, BIOSIS, ISI Web of Science, and the Cochrane Library were searched from January 1990 to December 2009. An updated search was undertaken with the use of MEDLINE and Embase from January 2010 to September 2016. Trials were included if they reported author-defined high- and low-GI or -GL diets and blood pressure, were of ≥6 wk duration, and comprised healthy participants without chronic conditions. Data were extracted and analyzed with the use of Stata statistical software. Pooled estimates and 95% CIs were calculated with the use of weighted mean differences and random-effects models. Data were extracted from 14 trials comprising 1097 participants. Thirteen trials provided information on differences in GI between control and intervention arms. A median reduction in GI of 10 units reduced the overall pooled estimates for SBP and DBP by 1.1 mm Hg (95% CI: -0.3, 2.5 mm Hg; = 0.11) and 1.3 mm Hg (95% CI: 0.2 mm Hg, 2.3; = 0.02), respectively. Nine trials reported information on differences in GL between arms. A median reduction in GL of 28 units reduced the overall pooled estimates for SBP and DBP by 2.0 mm Hg (95% CI: 0.2, 3.8 mm Hg; = 0.03) and 1.4 mm Hg (95% CI: 0.1, 2.6 mm Hg; = 0.03), respectively. This review of healthy individuals indicated that a lower glycemic diet may lead to important reductions in blood pressure. However, many of the trials included in the analysis reported important sources of bias. This trial was registered at PROSPERO as CRD42016049026.
Topics: Adult; Aged; Blood Pressure; Diet; Feeding Behavior; Female; Glycemic Index; Glycemic Load; Humans; Hypertension; Male; Middle Aged; Young Adult
PubMed: 28404579
DOI: 10.3945/ajcn.116.143685 -
Global Heart 2023Hypertension is a prevalent cardiovascular condition, with excessive sodium intake being a significant risk factor. Various studies have investigated measures to reduce... (Meta-Analysis)
Meta-Analysis Review
Effects of Behavioral Interventions for Salt Reduction on Blood Pressure and Urinary Sodium Excretion: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
Hypertension is a prevalent cardiovascular condition, with excessive sodium intake being a significant risk factor. Various studies have investigated measures to reduce salt intake, including integrated lifestyle interventions and health education. However, the effectiveness of behavioral interventions focused solely on salt reduction remains unclear. This systematic review and meta-analysis aimed to investigate the effects of a behavioral intervention based on salt reduction on blood pressure and urinary sodium excretion. A comprehensive search of the Cochrane Central Register of Controlled Trials, EMBASE, PubMed, and Web of Science was conducted to identify relevant literature. Study and intervention characteristics were extracted for descriptive synthesis, and the quality of the included studies was assessed. A total of 10 studies, comprising 4,667 participants (3,796 adults and 871 children), were included. The interventions involved the provision of salt-restriction spoons or devices, salt-reduction education, self-monitoring devices for urinary sodium, and salt-reduction cooking classes. Meta-analysis results showed that behavioral interventions focused on salt reduction significantly reduced systolic blood pressure (SBP) (-1.17 mmHg; 95% CI, -1.86 to -0.49), diastolic blood pressure (DBP) (-0.58 mmHg; 95% CI, -1.07 to -0.08) and urinary sodium excretion (-21.88 mmol/24 hours; 95% CI, -32.12 to -11.64). These findings suggest that behavioral change interventions centered on salt reduction can effectively lower salt intake levels and decrease blood pressure levels. However, to enhance effectiveness, behavioral interventions for salt reduction should be combined with other salt-reduction strategies.
Topics: Adult; Child; Humans; Blood Pressure; Sodium; Sodium Chloride, Dietary; Randomized Controlled Trials as Topic; Hypertension; Diet, Sodium-Restricted
PubMed: 38143483
DOI: 10.5334/gh.1281 -
The Cochrane Database of Systematic... Jun 2021Evidence indicates that reducing dietary salt may reduce the incidence of heart disease and delay decline in kidney function in people with chronic kidney disease (CKD).... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Evidence indicates that reducing dietary salt may reduce the incidence of heart disease and delay decline in kidney function in people with chronic kidney disease (CKD). This is an update of a review first published in 2015.
OBJECTIVES
To evaluate the benefits and harms of altering dietary salt for adults with CKD.
SEARCH METHODS
We searched the Cochrane Kidney and Transplant Register of Studies up to 6 October 2020 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov.
SELECTION CRITERIA
Randomised controlled trials comparing two or more levels of salt intake in adults with any stage of CKD.
DATA COLLECTION AND ANALYSIS
Two authors independently assessed studies for eligibility, conducted risk of bias evaluation and evaluated confidence in the evidence using GRADE. Results were summarised using random effects models as risk ratios (RR) for dichotomous outcomes or mean differences (MD) for continuous outcomes, with 95% confidence intervals (CI).
MAIN RESULTS
We included 21 studies (1197 randomised participants), 12 in the earlier stages of CKD (779 randomised participants), seven in dialysis (363 randomised participants) and two in post-transplant (55 randomised participants). Selection bias was low in seven studies, high in one and unclear in 13. Performance and detection biases were low in four studies, high in two, and unclear in 15. Attrition and reporting biases were low in 10 studies, high in three and unclear in eight. Because duration of the included studies was too short (1 to 36 weeks) to test the effect of salt restriction on endpoints such as death, cardiovascular events or CKD progression, changes in salt intake on blood pressure and other secondary risk factors were examined. Reducing salt by mean -73.51 mmol/day (95% CI -92.76 to -54.27), equivalent to 4.2 g or 1690 mg sodium/day, reduced systolic/diastolic blood pressure by -6.91/-3.91 mm Hg (95% CI -8.82 to -4.99/-4.80 to -3.02; 19 studies, 1405 participants; high certainty evidence). Albuminuria was reduced by 36% (95% CI 26 to 44) in six studies, five of which were carried out in people in the earlier stages of CKD (MD -0.44, 95% CI -0.58 to -0.30; 501 participants; high certainty evidence). The evidence is very uncertain about the effect of lower salt intake on weight, as the weight change observed (-1.32 kg, 95% CI -1.94 to -0.70; 12 studies, 759 participants) may have been due to fluid volume, lean tissue, or body fat. Lower salt intake may reduce extracellular fluid volume in the earlier stages of CKD (-0.87 L, 95% CI -1.17 to -0.58; 3 studies; 187 participants; low certainty evidence). The evidence is very uncertain about the effect of lower salt intake on reduction in antihypertensive dose (RR 2.45, 95% CI 0.98 to 6.08; 8 studies; 754 participants). Lower salt intake may lead to symptomatic hypotension (RR 6.70, 95% CI 2.40 to 18.69; 6 studies; 678 participants; moderate certainty evidence). Data were sparse for other types of adverse events.
AUTHORS' CONCLUSIONS
We found high certainty evidence that salt reduction reduced blood pressure in people with CKD, and albuminuria in people with earlier stage CKD in the short-term. If such reductions could be maintained long-term, this effect may translate to clinically significant reductions in CKD progression and cardiovascular events. Research into the long-term effects of sodium-restricted diet for people with CKD is warranted.
Topics: Antihypertensive Agents; Bias; Blood Pressure; Body Weight; Diet, Sodium-Restricted; Edema; Humans; Hypertension; Randomized Controlled Trials as Topic; Renal Insufficiency, Chronic; Selection Bias; Sodium Chloride, Dietary
PubMed: 34164803
DOI: 10.1002/14651858.CD010070.pub3 -
Complementary Therapies in Clinical... Nov 2022Acupuncture is a traditional therapy that can be potentially effective for treating high blood pressure. Grade 1 hypertension is a relatively mild form of hypertension.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Acupuncture is a traditional therapy that can be potentially effective for treating high blood pressure. Grade 1 hypertension is a relatively mild form of hypertension. This meta-analysis aims to assess the efficacy and safety of acupuncture in patients with grade 1 hypertension.
METHODS
We systematically searched the EMBASE, PubMed, Cochrane, China National Knowledge Infrastructure, and Wan Fang databases for randomised controlled trials investigating acupuncture therapy for grade 1 hypertension through March 2021. The primary outcomes were changes in blood pressure after acupuncture and efficacy of acupuncture. The secondary result was an adverse reaction to the treatment. Data were pooled and analysed using Review Manager 5.3 and Statistical Package for the Social Sciences software version 19.0.
RESULTS
Ten randomised controlled trials involving 1196 patients were included. Our meta-analysis demonstrated that in terms of changes in systolic blood pressure (MD 3.62 mmHg; 95% CI, 1.34 to 5.90; I = 56%), diastolic blood pressure (MD 3.12 mmHg; 95% CI, 1.03 to 5.20; I = 77%), and treatment efficacy (RR 2.12; 95% CI, 1.38 to 3.26; I = 93%), acupuncture is more effective in treating grade 1 hypertension than a placebo, no treatment at all, or interventions that improve lifestyle alone, with a low incidence of adverse effects. However, we did not find a suitable subgroup to reduce heterogeneity. Interventions, acupuncture methods, and treatment courses were not the only sources of heterogeneity among the studies.
CONCLUSION
Existing evidence shows that acupuncture could be used for treating hypertension; however, higher-quality randomised controlled trials are needed to better evaluate the safety and efficacy of acupuncture.
Topics: Humans; Acupuncture Therapy; Hypertension; Blood Pressure; Treatment Outcome; China; Randomized Controlled Trials as Topic
PubMed: 35963138
DOI: 10.1016/j.ctcp.2022.101649 -
The Cochrane Database of Systematic... Aug 2016Calcineurin inhibitors used in kidney transplantation for immunosuppression have adverse effects that may contribute to nephrotoxicity and increased cardiovascular risk... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Calcineurin inhibitors used in kidney transplantation for immunosuppression have adverse effects that may contribute to nephrotoxicity and increased cardiovascular risk profile. Fish oils are rich in very long chain omega-3 fatty acids, which may reduce nephrotoxicity by improving endothelial function and reduce rejection rates through their immuno-modulatory effects. They may also modify the cardiovascular risk profile. Hence, fish oils may potentially prolong graft survival and reduce cardiovascular mortality.
OBJECTIVES
This review aimed to look at the benefits and harms of fish oil treatment in ameliorating the kidney and cardiovascular adverse effects of CNI-based immunosuppressive therapy in kidney transplant recipients.
SEARCH METHODS
We searched the Cochrane Kidney and Transplant Specialised Register (up to 17 March 2016) through contact with the Information Specialist using search terms relevant to this review.
SELECTION CRITERIA
All randomised controlled trials (RCTs) and quasi-RCTs of fish oils in kidney transplant recipients on a calcineurin inhibitor-based immunosuppressive regimen. RCTs of fish oil versus statins were included.
DATA COLLECTION AND ANALYSIS
Data was extracted and the quality of studies assessed by two authors, with differences resolved by discussion with a third independent author. Dichotomous outcomes were reported as risk ratio (RR) and continuous outcome measures were reported as the mean difference (MD) with 95% confidence intervals using the random effects model. Heterogeneity was assessed using a Chi(2) test on n-1 degrees of freedom and the I(2) statistic. Data not suitable for pooling were tabulated and described.
MAIN RESULTS
Fifteen studies (733 patients) were suitable for analysis. All studies were small and had variable methodology. Fish oil did not significantly affect patient or graft survival, acute rejection rates, or calcineurin inhibitor toxicity when compared to placebo. Overall SCr was significantly lower in the fish oil group compared to placebo (5 studies, 237 participants: MD -30.63 µmol/L, 95% CI -59.74 to -1.53; I(2) = 88%). In the subgroup analysis, this was only significant in the long-course (six months or more) group (4 studies, 157 participants: MD -37.41 µmol/L, 95% CI -69.89 to -4.94; I(2) = 82%). Fish oil treatment was associated with a lower diastolic blood pressure (4 studies, 200 participants: MD -4.53 mm Hg, 95% CI -7.60 to -1.45) compared to placebo. Patients receiving fish oil for more than six months had a modest increase in HDL (5 studies, 178 participants: MD 0.12 mmol/L, 95% CI 0.03 to 0.21; I(2) = 47%) compared to placebo. Fish oil effects on lipids were not significantly different from low-dose statins. There was insufficient data to analyse cardiovascular outcomes. Fishy aftertaste and gastrointestinal upset were common but did not result in significant patient drop-out.
AUTHORS' CONCLUSIONS
There is insufficient evidence from currently available RCTs to recommend fish oil therapy to improve kidney function, rejection rates, patient survival or graft survival. The improvements in HDL cholesterol and diastolic blood pressure were too modest to recommend routine use. To determine a benefit in clinical outcomes, future RCTs will need to be adequately powered with these outcomes in mind.
Topics: Blood Pressure; Calcineurin Inhibitors; Fish Oils; Graft Rejection; Graft Survival; Humans; Kidney; Kidney Transplantation; Lipids; Randomized Controlled Trials as Topic
PubMed: 27535773
DOI: 10.1002/14651858.CD005282.pub3 -
Journal of Clinical Hypertension... Aug 2021The variability of blood pressure (BPV) has been suggested as a clinical indicator for cognitive dysfunction, yet the results from clinical studies are variable. This... (Meta-Analysis)
Meta-Analysis Review
The variability of blood pressure (BPV) has been suggested as a clinical indicator for cognitive dysfunction, yet the results from clinical studies are variable. This study investigated the relationship between BPV and the risk of cognitive decline or dementia. Bibliographic databases, including PubMed, Scopus, and Embase, were searched systematically for longitudinal cohort studies with BPV measurements and neuropsychological examinations or dementia diagnosis. A traditional meta-analysis with subgroup analysis, and a further dose-response meta-analysis were conducted. Twenty cohort studies with 7 924 168 persons were included in this review. The results showed that a higher systolic BPV (SBPV), when measured with the coefficient of variation (SBP-CV) or standard deviation (SBP-SD), was associated with a higher risk of all-cause dementia diagnosis but not incidence of cognitive decline on neuropsychological examinations. In subgroup analysis, the effect was more prominent when using BPV of shorter timeframes, during shorter follow-ups, or among the elderly aged more than 65 years. No dose-response relationship could be found. Our study suggested possible positive associations between SBPV and the risk of dementia. Further studies are required to validate these findings.
Topics: Aged; Blood Pressure; Cognitive Dysfunction; Cohort Studies; Humans; Hypertension; Longitudinal Studies; Risk Factors
PubMed: 34153171
DOI: 10.1111/jch.14310