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Efficacy and safety of Chinese herbal medicine for patients with postmenopausal hypertension: A systematic review and meta-analysis.
Xiong, X, Yang, X, Li, X, Yue, G, Xing, Y, Cho, WC
Pharmacological research. 2019;:481-500
Abstract
Chinese herbal medicine has been increasingly used for patients with postmenopausal hypertension in China. A comprehensive literature search was performed in 7 electronic databases from their inception up to December 17, 2017 to examine the efficacy and safety of Chinese herbal medicine for postmenopausal hypertension. Thirty-nine randomized controlled trials involving 3, 823 participants were included. Meta-analyses favored Chinese herbal medicine plus antihypertensive drugs on blood pressure, blood pressure variability, postmenopausal symptoms, quality of life, and hormone levels compared with antihypertensive drugs. No severe adverse effects were identified. Er-xian decoction was the most frequently prescribed herbal formula, while Rehmannia glutinosa Libosch. was the most commonly used single herb. Chinese herbal medicine as complementary therapy maybe beneficial for postmenopausal hypertension. However, the effectiveness and safety of the decoction are still uncertain due to methodological shortcomings. Well-conducted trials are warranted to resolve the issue.
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The efficacy of the Dietary Approaches to Stop Hypertension diet with respect to improving pregnancy outcomes in women with hypertensive disorders.
Jiang, F, Li, Y, Xu, P, Li, J, Chen, X, Yu, H, Gao, B, Xu, B, Li, X, Chen, W
Journal of human nutrition and dietetics : the official journal of the British Dietetic Association. 2019;(6):713-718
Abstract
BACKGROUND The DASH (Dietary Approaches to Stop Hypertension) diet serves as a dietary pattern for the prevention and control of hypertension. The present study aimed to investigate whether the DASH diet can improve the outcomes of pregnancy with gestational hypertension (GH) and chronic hypertension. METHODS The current randomised controlled clinical trial was performed in 85 pregnant women diagnosed with GH and chronic hypertension between July 2015 and December 2017. The women were categorised into a control group (41 cases) and a DASH group (44 cases). Participants were followed until delivery. The clinical outcomes of mothers included gestational weeks of birth, delivery mode, postpartum haemorrhage and GH, as well as the incidence of pre-eclampsia during the second and third trimesters. Newborn measurements were collected by evaluating prematurity, birth weight, body length and neonatal Apgar score. RESULTS The incidence of pre-eclampsia, prematurity and low birth weight in the DASH group was lower than that in the control group (P < 0.05). Significant differences were also observed in gestational age at delivery and the newborn body length between the two groups (P < 0.05). We failed to find a significant difference in changes of delivery mode, postpartum haemorrhage, postpartum GH, mean birth weight and Apgar score (P > 0.05) between the two diets. CONCLUSIONS A DASH diet might comprise a potential strategy for improving the clinical outcomes in pregnant women with GH and chronic hypertension. Future robust clinical trials are warranted to corroborate these findings.
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Self-management and blood pressure control in China: a community-based multicentre cross-sectional study.
Qu, Z, Parry, M, Liu, F, Wen, X, Li, J, Zhang, Y, Wang, D, Li, X
BMJ open. 2019;(3):e025819
Abstract
OBJECTIVES This study explored the relationship between self-management and blood pressure (BP) control in China. DESIGN A cross-sectional study. SETTING Eight community health centres from four cities in the Northeast (Shenyang), Northwest (Xi'an), Southwest (Chengdu) and South (Changsha) of China. PARTICIPANTS A total of 873 adults with hypertension, including 360 men and 513 women. Hypertension was defined as systolic BP ≥140 mm Hg and/or diastolic BP ≥90 mm Hg. OUTCOME MEASUREMENTS BP control was the primary outcome variable. This was categorised as good control if individuals with hypertension reduced their BP to <140/90 mm Hg, otherwise, it was categorised as poor control. Secondary outcomes included self-management, defined as: (1) context or condition-specific factors or physical/social environments (eg, age, sex, marital status, education, personal income and health insurance) and (2) process or knowledge/beliefs, self-regulation skills/abilities and social facilitation (eg, treatment, diet, exercise and risk factor management). Data were analysed using logistic regression models using SPSS V.20. RESULTS A total of 67.1% (n=586) participants had poor BP control. Limited outpatient care benefits in mainly rural residents (OR 2.26, 95% CI 1.06 to 4.81) and longer disease duration (OR 1.03, 95% CI 1.01 to 1.04) were associated with poor BP control. Self-management practices reduced the odds of having poor BP control (OR 0.98, 95% CI 0.97 to 0.99). CONCLUSIONS The individual and family self-management theory can serve as an effective theory for understanding the key contexts, processes and outcomes essential for BP control in China. Future research should evaluate the effect of a self-management intervention (eg, self-monitoring, medication adherence, regular and routine doctor visits, and social supports) for BP control in China using a multisite cluster randomised controlled trial. Sex and gender difference, cost and patient-reported outcomes should also be examined.
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Longitudinal association between fasting blood glucose concentrations and first stroke in hypertensive adults in China: effect of folic acid intervention.
Xu, RB, Kong, X, Xu, BP, Song, Y, Ji, M, Zhao, M, Huang, X, Li, P, Cheng, X, Chen, F, et al
The American journal of clinical nutrition. 2017;(3):564-570
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Abstract
Background: Diabetes is a known risk factor for stroke, but data on its prospective association with first stroke are limited. Folic acid supplementation has been shown to protect against first stroke, but its role in preventing first stroke in diabetes is unknown.Objectives: This post hoc analysis of the China Stroke Primary Prevention Trial tested the hypotheses that the fasting blood glucose (FBG) concentration is positively associated with first stroke risk and that folic acid treatment can reduce stroke risk associated with elevated fasting glucose concentrations.Design: This analysis included 20,327 hypertensive adults without a history of stroke or myocardial infarction, who were randomly assigned to a double-blind daily treatment with 10 mg enalapril and 0.8 mg folic acid (n = 10,160) or 10 mg enalapril alone (n = 10,167). Kaplan-Meier survival analysis and Cox proportionate hazard models were used to test the hypotheses with adjustment for pertinent covariables.Results: During a median treatment duration of 4.5 y, 616 participants developed a first stroke (497 ischemic strokes). A high FBG concentration (≥7.0 mmol/L) or diabetes, compared with a low FBG concentration (<5.0 mmol/L), was associated with an increased risk of first stroke (6.0% compared with 2.6%, respectively; HR: 1.9; 95% CI: 1.3, 2.8; P < 0.001). Folic acid treatment reduced the risk of stroke across a wide range of FBG concentrations ≥5.0 mmol/L, but risk reduction was greatest in subjects with FBG concentrations ≥7.0 mmol/L or with diabetes (HR: 0.66; 95% CI: 0.46, 0.97; P < 0.05). There was a significant interactive effect of FBG and folic acid treatment on first stroke (P = 0.01).Conclusions: In Chinese hypertensive adults, an FBG concentration ≥7.0 mmol/L or diabetes is associated with an increased risk of first stroke; this increased risk is reduced by 34% with folic acid treatment. These findings warrant additional investigation. This trial was registered at clinicaltrials.gov as NCT00794885.
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Telmisartan and hydrochlorothiazide antihypertensive treatment in high sodium intake population: a randomized double-blind trial.
Zhang, P, Wang, H, Sun, L, Zhang, J, Xi, Y, Wu, Y, Yan, LL, Li, X, Sun, N
Journal of hypertension. 2017;(10):2077-2085
Abstract
OBJECTIVES To compare the blood pressure (BP)-lowering effects of telmisartan 40 mg/day and hydrochlorothiazide (HCTZ) 25 mg/day in high sodium intake patients with mild-to-moderate hypertension in China. METHODS In this randomized, double-blind trial, eligible patients were randomly divided into telmisartan and HCTZ groups with three follow-ups scheduled on days 15, 30, and 60 after enrollment to compare BP decrease, hypokalemia, and other adverse events after intervention. RESULTS A total of 1333 mild-to-moderate hypertensive patients with average sodium intake of 5909 mg/day were enrolled from 14 county hospitals in China. Baseline characteristics were well balanced. At 15, 30, and 60 days of follow-up, average SBP/DBP reduction in telmisartan and HCTZ group was 12.5/8.0, 14.3/9.1, 12.8/7.2, 11.0/5.8, 13.6/7.1, and 11.5/5.3 mmHg, respectively. Telmisartan showed greater BP response than HCTZ at three visits, with statistical significance for DBP (P < 0.001) regardless of the adjustment for baseline BP, sodium excretion, and pulse pressure (PP). SBP reduction was positively related to increasing urinary sodium and PP levels for patients in both groups but increased faster with increasing PP in HCTZ than in telmisartan (P = 0.0238 for group × PP). Compared with telmisartan, HCTZ showed more hypokalemia (0.4 vs. 4.5%, P < 0.001). CONCLUSION Both telmisartan and HCTZ were effective for the treatment of hypertensive patients with high sodium intake. Telmisartan showed better DBP-lowering effect and less hypokalemia than HCTZ among high sodium intake patients. Further studies are needed to evaluate the plausible superiority effect of hydrochlorothiazide among patients with large PP.
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Effect of Baduanjin exercise for hypertension: a systematic review and meta-analysis of randomized controlled trials.
Xiong, X, Wang, P, Li, S, Zhang, Y, Li, X
Maturitas. 2015;(4):370-8
Abstract
This study aims to evaluate the efficacy of Baduanjin exercise for hypertension. Cochrane Library, PubMed, EMBASE, CNKI, VIP, CBM and Wanfang databases were searched. Eight randomized controlled trials (RCTs) were identified. Baduanjin significantly lowered systolic blood pressure (SBP) (WMD=-13.00 mmHg; 95% CI: -21.24 to -4.77; P=0.002), diastolic blood pressure (DBP) (WMD=-6.13 mmHg; 95% CI: -11.20 to -1.07; P=0.02), body mass index, blood glucose, triglyceride, and low-density lipoprotein-cholesterol, and improved high-density lipoprotein-cholesterol and quality of life compared to no intervention. No significant difference between Baduanjin and antihypertensive drugs on SBP (WMD=1.05 mmHg; 95% CI: -2.07 to 4.17; P=0.51) or DBP (WMD=1.90 mmHg; 95% CI: -1.22 to 5.02; P=0.23) was identified. Baduanjin plus antihypertensive drugs significantly reduced SBP (WMD=-7.49 mmHg; 95% CI: -11.39 to -3.59; P=0.0002), DBP (WMD=-3.55 mmHg; 95% CI: -5.25 to -1.85; P<0.0001), blood glucose, and total cholesterol compared to antihypertensive drugs. Baduanjin is an effective therapy for hypertension. However, further rigorously designed RCTs are still warranted.
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Efficacy of folic acid therapy in primary prevention of stroke among adults with hypertension in China: the CSPPT randomized clinical trial.
Huo, Y, Li, J, Qin, X, Huang, Y, Wang, X, Gottesman, RF, Tang, G, Wang, B, Chen, D, He, M, et al
JAMA. 2015;(13):1325-35
Abstract
IMPORTANCE Uncertainty remains about the efficacy of folic acid therapy for the primary prevention of stroke because of limited and inconsistent data. OBJECTIVE To test the primary hypothesis that therapy with enalapril and folic acid is more effective in reducing first stroke than enalapril alone among Chinese adults with hypertension. DESIGN, SETTING, AND PARTICIPANTS The China Stroke Primary Prevention Trial, a randomized, double-blind clinical trial conducted from May 19, 2008, to August 24, 2013, in 32 communities in Jiangsu and Anhui provinces in China. A total of 20,702 adults with hypertension without history of stroke or myocardial infarction (MI) participated in the study. INTERVENTIONS Eligible participants, stratified by MTHFR C677T genotypes (CC, CT, and TT), were randomly assigned to receive double-blind daily treatment with a single-pill combination containing enalapril, 10 mg, and folic acid, 0.8 mg (n = 10,348) or a tablet containing enalapril, 10 mg, alone (n = 10,354). MAIN OUTCOMES AND MEASURES The primary outcome was first stroke. Secondary outcomes included first ischemic stroke; first hemorrhagic stroke; MI; a composite of cardiovascular events consisting of cardiovascular death, MI, and stroke; and all-cause death. RESULTS During a median treatment duration of 4.5 years, compared with the enalapril alone group, the enalapril-folic acid group had a significant risk reduction in first stroke (2.7% of participants in the enalapril-folic acid group vs 3.4% in the enalapril alone group; hazard ratio [HR], 0.79; 95% CI, 0.68-0.93), first ischemic stroke (2.2% with enalapril-folic acid vs 2.8% with enalapril alone; HR, 0.76; 95% CI, 0.64-0.91), and composite cardiovascular events consisting of cardiovascular death, MI, and stroke (3.1% with enalapril-folic acid vs 3.9% with enalapril alone; HR, 0.80; 95% CI, 0.69-0.92). The risks of hemorrhagic stroke (HR, 0.93; 95% CI, 0.65-1.34), MI (HR, 1.04; 95% CI, 0.60-1.82), and all-cause deaths (HR, 0.94; 95% CI, 0.81-1.10) did not differ significantly between the 2 treatment groups. There were no significant differences between the 2 treatment groups in the frequencies of adverse events. CONCLUSIONS AND RELEVANCE Among adults with hypertension in China without a history of stroke or MI, the combined use of enalapril and folic acid, compared with enalapril alone, significantly reduced the risk of first stroke. These findings are consistent with benefits from folate use among adults with hypertension and low baseline folate levels. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00794885.
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Shenqi pill, a traditional Chinese herbal formula, for the treatment of hypertension: A systematic review.
Xiong, X, Wang, P, Li, X, Zhang, Y
Complementary therapies in medicine. 2015;(3):484-93
Abstract
BACKGROUND Shenqi pill, a traditional Chinese herbal formula, is widely prescribed for hypertensive patients with kidney yang deficiency syndrome in China. This study aims to examine the efficacy and safety of Shenqi pill for the treatment of hypertension. METHODS A systematic search of the Cochrane Central Register of Controlled Trials, PubMed, EMBASE, the Chinese National Knowledge Infrastructure, the Chinese Scientific Journal Database, the Chinese Biomedical Literature Database, and the Wanfang Database was conducted from their inception up to October 7, 2014. All randomized controlled trials (RCTs) testing Shenqi pill alone or combined with western medicine against placebo, no intervention or western medicine in hypertensive patients were included. RESULTS A total of 4 RCTs comparing Shenqi pill plus western medicine with western medicine were included. Shenqi pill as complementary therapy exhibited a relatively small with no significant reduction on blood pressure, and showed remarkable improvement on sexual function, lipid profile and some biochemical indicators of hypertensive renal damage compared to western medicine used alone. The safety of Shenqi pill is still unknown. CONCLUSIONS This systematic review firstly provided no definite evidence for the efficacy and safety of Shenqi pill for hypertension based on the insufficient data. More rigorously designed RCTs focusing on sexual dysfunction and hypertensive renal damage are warranted to give high level of evidence.
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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.
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The multiple lifestyle modification for patients with prehypertension and hypertension patients: a systematic review protocol.
Li, J, Zheng, H, Du, HB, Tian, XP, Jiang, YJ, Zhang, SL, Kang, Y, Li, X, Chen, J, Lu, C, et al
BMJ open. 2014;(8):e004920
Abstract
INTRODUCTION The objective of this systematic review is to investigate the effectiveness, efficacy and safety of multiple concomitant lifestyle modification therapies for patients with hypertension or prehypertension. METHODS AND ANALYSIS Electronic searches will be performed in the Cochrane Library, OVID, EMBASE, etc, along with manual searches in the reference lists of relevant papers found during electronic search. We will identify eligible randomised controlled trials utilising multiple lifestyle modifications to lower blood pressure. The control could be drug therapy, single lifestyle change or no intervention. Changes in systolic blood pressure and diastolic blood pressure constitute primary end points, and secondary end points include the number of patients meeting the office target blood pressure, the number of patients reporting microvascular or macrovascular complications, etc. We will extract descriptive, methodological and efficacy data from identified randomised controlled trials (RCTs). We will calculate the relative risk for proportion of patients with a normal blood pressure in the experimental group. Dichotomous data will be analysed using risk difference and continuous data using weighted mean differences, both with 95% CI. We will use the χ(2) test and the I(2) statistic to assess heterogeneity. We will use the fixed effects model to compute the efficacy unless there is evidence of heterogeneity. If heterogeneity of effect size persists with respect to blood pressure change, further metaregression will be performed within groups. We will examine the potential for publication bias by using a funnel plot. DISSEMINATION We will synthesise results from RCTs which provide more precise and accurate information on the effect of multiple lifestyle changes on blood pressure. The results of this review will increase the understanding of multiple lifestyle modifications for patients with hypertension or prehypertension. TRAIL REGISTRATION NUMBER Our protocol is registered on PROSPERO (CRD42013006476), http://www.crd.your.ac.uk/PROSPERO.