活血化瘀法治疗原发性高血压临床随机对照试验有效性和安全性系统评价与Meta分析

The Effectiveness and Safety of Promoting Circulation to Remove Stasis in the Treatment for Essential Hypertension:System Review and Meta Analysis

目的评价采用"活血化瘀"法治疗原发性高血压(EH)的有效性和安全性。方法检索Cochrane图书馆、PubMed、Embase、Wiley、Ovid、Clinical Trials.gov、中国知网、维普、中国生物医学文献数据库、万方数据库、SIGLE灰色文献数据库建库至今以"活血化瘀法"治疗EH的临床随机对照试验(RCT),按照Cochrane系统评价方法对符合纳入标准的文献进行数据提取和质量评价,采用Rev-Man 5.2软件进行Meta分析。结果最终共纳入26篇RCT,3 288例EH病人。Meta分析和系统评价结果显示与单纯西药治疗相比,活血化瘀类中药能够有效降低病人收缩压[SMD=-0.40,95%CI(-0.61,-0.91)]和舒张压水平[SMD=-0.54,95%CI(-0.76,-0.33)],提高降压疗效[OR=2.73,95%CI(1.94,3.85)],降低病人临床症状积分[MD=-4.71,95%CI(-6.17,-3.25)],提高症状疗效[OR=4.97,95%CI(3.04,8.13)],改善生存质量,且安全性较好。结论目前证据支持采用"活血化瘀"的治疗方法,可提高EH的降压疗效,改善和缓解病人的临床症状和生活质量,且安全性较好。

Objective To evaluate the effectiveness and safety of the method of promoting blood circulation to remove blood stasis in the treatment for essential hypertension（EH）.Methods PubMed,Cochrane Library,EMBASE,Wiley,Ovid,Clinical Trials.gov,Cochrane Central Register of Controlled Trials,VIP,ChiCTR,CBM,CNKI,and Wanfang were searched to identify relevant studies.Studies were identified and selected,and data were extracted by two independent reviewers.The Cochrane Risk of Bias tool was used to assess the quality of studies.Revman 5.3 software was used for date synthesis and analysis.Results In this review,twenty-six studies,3 288 patients of EH were included based on the selection criteria.In the overall analysis,promoting blood circulation to remove blood stasis resulted in significantly higher antihypertensive effective rate[OR =2.73,95% CI（1.94,3.85）]and symptom effective rate[OR =4.97,95% CI（3.04,8.13）]lower levels of systolic blood pressure[SMD =-0.40,95% CI（-0.61-0.91）]and diastolic blood pressure[SMD =-0.54,95% CI（-0.76,-0.33）],syndrome integral[MD =-4.71,95% CI（-6.17,-3.25）],improve ment of the quality of life improve the quality of life and the security as compared to that of western medicine treated to Primary Hypertension.Sensitivity analysis indicated that findings of the meta-analysis were robust to study quality and funnel plot showed no publication bias.Conclusion Currently,the evidence supports the method of ‘promoting blood circulation to remove blood stasis＇ could improve the antihypertensive effects of primary hypertension,the clinical symptoms and quality of life of patients.Besides,the security is betfer.