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Effect of Vitamin D on Blood Pressure and Hypertension in the General Population: An Update Meta-Analysis of Cohort Studies and Randomized Controlled Trials.
Zhang, D, Cheng, C, Wang, Y, Sun, H, Yu, S, Xue, Y, Liu, Y, Li, W, Li, X
Preventing chronic disease. 2020;:E03
Abstract
BACKGROUND The effect of vitamin D supplementation on blood pressure has been explored in previous meta-analyses, but whether the association is causal in the general population is still unknown. We evaluated the association comprehensively and quantitatively. METHODS We searched PubMed and Embase for relevant cohort studies and randomized controlled trials (RCTs). We used a 2-step generalized least-squares method to assess the dose-response association of circulating 25-hydroxyvitamin D (25[OH]D) and hypertension and a fixed-effects model to pool the weighted mean differences (WMDs) and corresponding 95% confidence intervals (95% CIs) of blood pressure across RCTs. RESULTS We identified 11 cohort studies and 27 RCTs, with 43,320 and 3,810 participants, respectively. The dose-response relationship between circulating 25(OH)D levels and hypertension risk was approximately L-shaped (Pnonlinearity = .04), suggesting that the risk of hypertension increased substantially below 75 nmol/L as 25(OH)D decreased, but it remained significant over the range of 75-130 nmol/L. However, pooled results of RCTs showed that there was no significant reduction in systolic blood pressure (WMD, -0.00 mm Hg; 95% CI, -0.71 to 0.71) or diastolic blood pressure (WMD, 0.19 mm Hg; 95% CI, -0.29 to 0.67) after vitamin D intervention. CONCLUSIONS The results of this meta-analysis indicate that supplementation with vitamin D does not lower blood pressure in the general population. RCTs with long-term interventions and a sufficient number of participants who have low levels of vitamin D are needed to validate these findings.
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Risk of orthostatic hypotension associated with sodium-glucose cotransporter-2 inhibitor treatment: A meta-analysis of randomized controlled trials.
Rong, X, Li, X, Gou, Q, Liu, K, Chen, X
Diabetes & vascular disease research. 2020;(5):1479164120953625
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Abstract
OBJECTIVE The aim of this study was to assess the association between sodium-glucose cotransporter-2 (SGLT2) inhibitors and the risk of orthostatic hypotension (OH) in patients with type 2 diabetes mellitus (T2DM). METHOD A systematic literature retrieval was performed using PubMed, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception up to 16 October 2019. Data for study characteristics and outcomes of interest were extracted from each eligible study. Pooled risk ratios (RRs) with 95% confidence intervals (CI) for OH were calculated using a random-effects model. RESULT A total of 16 studies (nā=ā12,749) were included in our meta-analysis, with a result of 44 incident OH cases (29 in the SGLT2 inhibitor group, and 15 in the control group). The pooled RR was 1.17 (95% CI: 0.65-2.09). There was no evidence that receiving SGLT2 inhibitors increased the risk of OH, when stratified by age, duration of T2DM, or placebo-control or active-control and baseline blood pressure. CONCLUSION This meta-analysis suggested that, in general, SGLPT2 inhibitors did not increase the risk of OH in patients with T2DM. The possibility of OH should be, therefore, considered on an individual basis, especially in patients with a history of OH, long duration of T2DM, or comorbidities.
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The genetics of blood pressure regulation and its target organs from association studies in 342,415 individuals.
Ehret, GB, Ferreira, T, Chasman, DI, Jackson, AU, Schmidt, EM, Johnson, T, Thorleifsson, G, Luan, J, Donnelly, LA, Kanoni, S, et al
Nature genetics. 2016;(10):1171-1184
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Abstract
To dissect the genetic architecture of blood pressure and assess effects on target organ damage, we analyzed 128,272 SNPs from targeted and genome-wide arrays in 201,529 individuals of European ancestry, and genotypes from an additional 140,886 individuals were used for validation. We identified 66 blood pressure-associated loci, of which 17 were new; 15 harbored multiple distinct association signals. The 66 index SNPs were enriched for cis-regulatory elements, particularly in vascular endothelial cells, consistent with a primary role in blood pressure control through modulation of vascular tone across multiple tissues. The 66 index SNPs combined in a risk score showed comparable effects in 64,421 individuals of non-European descent. The 66-SNP blood pressure risk score was significantly associated with target organ damage in multiple tissues but with minor effects in the kidney. Our findings expand current knowledge of blood pressure-related pathways and highlight tissues beyond the classical renal system in blood pressure regulation.
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The effect of Chinese herbal medicine Jian Ling Decoction for the treatment of essential hypertension: a systematic review.
Xiong, X, Wang, P, Li, X, Zhang, Y
BMJ open. 2015;(2):e006502
Abstract
OBJECTIVES Jian Ling Decoction (JLD) is often prescribed to improve hypertension-related symptoms in China. However, this treatment has not been systematically reviewed for its efficacy against essential hypertension (EH). This review aims to assess the current clinical evidence of JLD in the treatment of EH. DESIGN Seven electronic databases, including the Cochrane Central Register of Controlled Trials, PubMed, EMBASE, the Chinese National Knowledge Infrastructure (CNKI), the Chinese Scientific Journal Database (VIP), the Chinese Biomedical Literature Database (CBM) and the Wanfang Database, were searched up to March 2014. Randomised control trials (RCTs) comparing JLD or combined with antihypertensive drugs versus antihypertensive drugs were included. We assessed the methodological quality, extracted the valid data and conducted the meta-analysis according to criteria from the Cochrane group. The primary outcome was categorical or continuous blood pressure (BP), and the secondary outcome was quality of life (QOL). RESULTS Ten trials (655 patients) with unclear-to-high risk of bias were identified. Meta-analysis showed that JLD used alone showed no BP reduction effect; however, improvement on QOL was found in the JLD group compared to antihypertensive drugs. A significant reduction in systolic and diastolic BP was observed for JLD plus antihypertensive drugs when compared with antihypertensive drugs alone. No serious adverse effects were reported. CONCLUSIONS Owing to insufficient clinical data, it is difficult to draw a definite conclusion regarding the effectiveness and safety of JLD for EH, and better trials are needed.