心脏健康膳食模式对血压影响的系统评价与荟萃分析

Effect of heart-healthy dietary patterns on blood pressure:a systematic review and meta-analysis

目的系统评价心脏健康膳食模式的降压作用。方法通过计算机检索PubMed、Embase、the Cochrane Library、Web of Science、Scopus、中国知网、中国生物医学文献服务系统、万方数据库、维普网从建库至2023年2月有关地中海膳食、终止高血压膳食(DASH)和中国心脏健康膳食对血压影响的随机对照试验,评估筛选到的文献后进行系统评价和荟萃分析。结果纳入27项研究,包含研究对象7409人,其中试验组3677人,对照组3732人。27项研究的荟萃分析结果显示,心脏健康膳食模式具有降低收缩压[加权均数差(WMD)=-4.03 mmHg,95%CI-4.82~-3.24 mmHg,P<0.001]和舒张压(WMD=-2.26 mmHg,95%CI-2.96~-1.55 mmHg,P<0.001)的作用。对排除高偏倚风险研究后的15项研究进行荟萃分析,结果显示,心脏健康膳食模式可以有效降低收缩压(WMD=-3.94 mmHg,95%CI-5.10~-2.77 mmHg,P<0.001)和舒张压(WMD=-2.32 mmHg,95%CI-3.01~-1.63 mmHg,P<0.001)。亚组分析显示,心脏健康膳食在研究对象的不同性别、体重指数、基线血压状态、试验组的膳食模式、对照组是否存在膳食干预和干预时间分层下,均可以有效降低收缩压与舒张压,在18岁以下和40~<65岁的人群中可有效降低收缩压,在18~<65岁的人群中可有效降低舒张压。结论心脏健康膳食模式对血压管理有明显的积极影响。

Objective To systematically evaluate the impact of heart-healthy dietary patterns in reducing blood pressure.Methods PubMed,Embase,the Cochrane Library,Web of Science,Scopus,China Knowledge Network,China Biomedical Literature Service,Wanfang Database,and Weipu were searched to collect randomized controlled trials(RCTs)that related to the antihypertensive effects of Mediterranean diet,dietary approaches to stop hypertension(DASH)and Chinese heart-healthy(CHH)diet from inception to February 2023.A systematic evaluation and meta-analysis was conducted after evaluating the selected literature.Results A total of 27 studies were included,comprising 7409 participants,including 3677 in the intervention group and 3732 in the control group.Metaanalysis of 27 studies showed that heart-healthy dietary patterns can reduce both systolic blood pressure[weighted mean difference(WMD)=-4.03 mmHg,95%CI-4.82 to-3.24 mmHg,P<0.001]and diastolic blood pressure(WMD=-2.26 mmHg,95%CI-2.96 to-1.55 mmHg,P<0.001).A meta-analysis of 15 studies after exclusion of studies with high risk of bias showed that heart-healthy dietary patterns can effectively reduce systolic blood pressure(WMD=-3.94 mmHg,95%CI-5.10 to-2.77 mmHg,P<0.001)and diastolic blood pressure(WMD=-2.32 mmHg,95%CI-3.01 to-1.63 mmHg,P<0.001).Subgroup analyses showed that heart-healthy dietary patterns were effective in reducing both systolic and diastolic blood pressure in different subgroups based on the population's gender,body mass index,and baseline blood pressure status,the dietary patterns of the intervention group,the presence of dietary interventions in the control group,and the overall duration of the intervention.Heart-healthy diet was effective in reducing systolic blood pressure in people under 18 years old and those between 40-<65 years old,while in people aged 18-<65 years,it was effective in reducing diastolic blood pressure.Conclusion Heart-healthy dietary patterns have a significant positive impact on blood pressure management.