焦虑和/或抑郁情绪对老年原发性高血压病患者血压影响的Meta分析

Impact of Anxiety and/or Depression on Blood Pressure in Elderly Patients with Essential Hypertension:a Metaanalysis

背景随着人口老龄化逐渐加重,老年原发性高血压病患者焦虑、抑郁发生率升高,近年关于老年原发性高血压病患者负性情绪与血压相关性的研究较多,但结论并不一致,临床尚缺乏循证医学研究证明老年原发性高血压病患者焦虑、抑郁情绪与血压的关系。目的系统评价焦虑和/或抑郁情绪对老年原发性高血压病患者血压的影响。方法计算机检索PubMed、Web of Science、Medline、EBSCO、中国知网、万方数据知识服务平台、维普网及中国生物医学文献数据库,检索时间为建库至2019年10月。观察组为老年原发性高血压病伴焦虑和/或抑郁情绪患者,对照组为老年原发性高血压病无焦虑、抑郁情绪患者。比较两组患者血压变异性(BPV)指标、动态血压指标、非杓型血压节律发生率,并采用Begg秩相关分析、漏斗图评价结局指标的发表偏倚。结果最终纳入文献19篇,共包含2240例患者,其中对照组1150例,观察组1090例。Meta分析结果显示,观察组患者24 h收缩压标准差(24 h SBPSD)[平均差(MD)=1.07,95%CI(0.49,1.65)]、昼间收缩压标准差(dSBPSD)[MD=2.20,95%CI(1.09,3.31)]、夜间收缩压标准差(MD=nSBPSD)[MD=0.85,95%CI(0.53,1.16)]、昼间收缩压变异系数(dSBP-CV)[3.23,95%CI(M0.67,5.79)]、24 h收缩压(24 h SBP)[MD=9.47,95%CI(6.03,12.90)]、24 h舒张压(24 h DBP)[D=4.71,95%CI(2.63,6.78)]、昼间收缩压(dSBP)[MD=7.65,95%CI(4.86,10.43)]、昼间舒张压(dDBP)[MD=2.76,95%CI(1.48,4.05)]、夜间收缩压(nSBP)[MD=8.45,95%CI(5.42,11.48)]和夜间舒张压(nDBP)[MD=4.49,95%CI(2.23,6.76)]均高于对照组(P<0.05);两组患者非杓型血压节律发生率比较,差异无统计学意义[OR=1.63,95%CI(0.89,3.00),P=0.12]。采用逐一排除法进行敏感性分析,发现MD值未见明显变化,表明本Meta分析结果的稳定性较好。结论本Meta分析结果表明,焦虑和/或抑郁情绪可增加老年原发性高血压病患者动态血压变化幅度和BPV,尤其是收缩压变异性,与非杓型血压节律可能无关系。

Background With the aggravating aging of population,the incidence of anxiety and depression in elderly patients with essential hypertension also increased.Recently,there are many studies on the correlation between negative emotions and blood pressure in elderly patients with essential hypertension,but the conclusion is contradictory.Evidence-based medical research for the relationship between anxiety,depression,and blood pressure in elderly patients with essential hypertension is limited clinically.Objective To systematically assess the impact of anxiety and/or depression on blood pressure in elderly patients with essential hypertension.Methods Electronic databases of PubMed,Web of Science,Medline,EBSCO,CNKI,WanFang Data,VIP and CMB were searched up to October 2019.The observation group was for elderly patients with essential hypertension with anxiety and/or depression,while the control group was whom without it.Blood pressure variability(BPV),ambulatory blood pressure(ABP)and incidence of non-dipper blood pressure rhythm were compared between the two groups,and publication bias of outcome indicators was evaluated by the Begg rank correlation method and funnel diagram.Results A total of 19 studies involving 2240 cases were included(control group for 1150 cases and observation group for 1090 cases).The results of Meta-analysis showed that,compared with control group,24 h systolic blood pressure standard deviation(24 h SBPSD)〔MD=1.07,95%CI(0.49,1.65)〕,diurnal systolic blood pressure standard deviation(dSBPSD)〔MD=2.20,95%CI(1.09,3.31)〕,diurnal systolic blood pressure variation coefficient(dSBP-CV)〔MD=3.23,95%CI(0.67,5.79)〕,24 h systolic blood pressure(24 h SBP)〔MD=9.47,95%CI(6.03,12.90)〕,24 h diastolic blood pressure(24 h DBP)〔MD=4.71,95%CI(2.63,6.78)〕,diurnal systolic blood pressure(dSBP)〔MD=7.65,95%CI(4.86,10.43)〕,diastolic blood pressure(dDBP)〔MD=2.76,95%CI(1.48,4.05)〕,night systolic blood pressure(nSBP)〔MD=8.45,95%CI(5.42,11.48)〕and night diastolic blood pressure(nDBP)〔MD=4.49,95%CI(2.23,6.76)〕were higher in observation group(P<0.05);there was no statistical difference in the incidence of non-dipper blood pressure rhythm between the two groups〔OR=1.63,95%CI(0.89,3.00),P=0.12〕.Conclusion With the results of this meta-analysis,anxiety and/or depression can elevate the ambulatory blood pressure and BPV for elderly patients with essential hypertension,especially in the variability of systolic blood pressure,may not be related to the non-dipper blood pressure rhythm.