Comprehensive effects of traditional Chinese medicine treatment on heart failure and changes in B-type natriuretic peptide levels: A meta-analysis

BACKGROUND Heart failure(HF),a common cardiovascular condition,is characterized by significant morbidity and mortality.While traditional Chinese medicine(TCM)is often used as a complementary approach in HF management,systematic evalua-tions of its impact on clinical outcomes,TCM syndrome scores,and B-type natriuretic peptide(BNP)levels are lacking.This study fills this gap through a comprehensive analysis of randomized controlled trials(RCTs)focusing on TCM for HF treatment.It encompasses an assessment of methodological quality,a meta-analysis,and an evaluation of evidence quality based on established standards.The results offer crucial insights into the potential advantages and constraints of TCM in HF management.RCTs on TCM for HF treatment published since the establishment of the database were searched in four Chinese and English databases,including China National Knowledge Infrastructure,Wanfang,VIP Information Chinese Science and Technology Journal,and PubMed.Methodological quality was assessed for the included studies with the Cochrane risk-of-bias assessment tool,and the meta-analysis and publication bias assessment was performed with the RevMan5.3 software.Finally,the quality of evidence was rated according to the GRADE criteria.RESULTS A total of 1098 RCTs were initially retrieved.After screening,16 RCTs were finally included in our study,which were published between 2020 and 2023.These RCTs involved 1660 HF patients,including 832 in the TCM group[TCM combined with conventional Western medicine(CMW)treatment]and 828 in the CWM group(CWM treatment).The course of treatments varied from 1 wk to 3 months.TCM syndrome differentiation was analyzed in 11 of the included RCTs.In all included RCTs,outcome indicators included comprehensive clinical outcomes,TCM syndrome scores,and BNP levels.The meta-analysis results showed significant differences between the TCM and CWM groups in terms of comprehensive clinical outcomes[risk ratio=-0.54;95%confidence interval(CI)=-0.61,-0.47;P<0.00001],TCM syndrome scores[weighted mean difference(WMD)=-142.07;95%CI=-147.56,-136.57;P<0.00001],and BNP levels(WMD=-142.07;95%CI=-147.56,-136.57;P<0.00001).According to the GRADE criteria,RCTs where"TCM improves clinical comprehensive outcomes"were rated as low-quality evidence,and RCTs where"TCM reduces TCM syndrome scores"or"TCM decreases BNP levels"were rated as medium-quality evidence.CONCLUSION TCM combined with CWM treatment effectively improves comprehensive clinical outcomes and diminishes TCM syndrome scores and BNP levels in HF patients.Given the low and medium quality of the included RCTs,the application of these results should be cautious.

Exploring the mechanism of Pinggan Yishen granules in the treatment of hypertension and insomnia through network pharmacology and molecular docking

Background:Hypertension is closely related to insomnia.Pinggan Yishen(PGYS)Granule is an effective compound medicine for treating hypertension and insomnia.In this study,we aimed to systematically explain the potential mechanism of PGYS granules in the treatment of hypertension and insomnia using network pharmacology and molecular docking techniques.Methods:Potential targets accounted for hypertension and insomnia were obtained from OMIM,GeneCards,and DrugBank databases.We used the Batman-TCM database to query natural compounds and potential targets associated with PGYS granules.According to the localization results of PGYS granules and potential target genes of disease,the protein-protein interaction network was constructed.The tissue and subcellular distribution information for key proteins are visualized.Used KOBAS3.0 to enrich KEGG pathways and GO biological processes.Molecular docking was used to verify relationships between core compounds and proteins.Results:The comorbid mechanism of hypertensive insomnia is mainly related to disorders of neurotransmitter regulation,imbalance of the renin-angiotensin-aldosterone system(RAAS),abnormal metabolism including cytokine secretion and lipid metabolism.The potential therapeutic mechanisms of PGYS granules include the regulation of neurotransmitters,lipid metabolism and inflammatory response.CACNA1C,adrenergic receptors,cytochrome P450 family and muscarinic cholinergic receptors may be the key targets of PGYS granules.Conclusion:Hypertension and insomnia are related in mechanisms.PGYS granules may play a therapeutic role in hypertension and insomnia by regulating neurotransmitters,lipid metabolism and inflammatory response.