Musini Vijaya M, Wright James M
Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
PLoS One. 2009 May 22;4(5):e5673. doi: 10.1371/journal.pone.0005673.
Systematic reviews can often reveal much more than the original objective of the work. The objectives of this retrospective analysis were to answer three basic questions about blood pressure variability: 1) Does blood pressure entry criterion have an effect on baseline blood pressure variability? 2) Do thiazide diuretics have a significant effect on blood pressure variability? and 3) Does systolic blood pressure vary to the same degree as diastolic blood pressure? This analysis of blood pressure variability is based on resting standardized research setting BP readings from two systematic reviews evaluating blood pressure lowering efficacy of thiazide diuretics from double blind randomized controlled trials in 33,611 patients with primary hypertension. The standard deviation reported in trials was the focus of the research and the unit of analysis. When a threshold systolic or diastolic blood pressure value is used to determine entry into a trial, baseline variability is significantly decreased, systolic from 14.0 to 9.3 mmHg and diastolic from 8.4 to 5.3 mmHg. Thiazides do not change BP variability as the standard deviation and coefficient of variation of systolic blood pressure and diastolic blood pressure did not differ between thiazide and placebo groups at end of treatment. The coefficient of variation of systolic blood pressure was significantly greater than the coefficient of variation of diastolic blood pressure. Entry criterion decreases the baseline blood pressure variability. Treatment with a thiazide diuretic does not affect blood pressure variability. Systolic blood pressure varies to a greater degree than diastolic blood pressure.
系统评价往往能揭示出比研究最初目标更多的内容。这项回顾性分析的目的是回答关于血压变异性的三个基本问题:1)血压纳入标准对基线血压变异性有影响吗?2)噻嗪类利尿剂对血压变异性有显著影响吗?以及3)收缩压和舒张压的变化程度相同吗?这项血压变异性分析基于两项系统评价中静息状态下标准化研究设置的血压读数,这两项系统评价评估了33611例原发性高血压患者在双盲随机对照试验中噻嗪类利尿剂的降压疗效。试验中报告的标准差是研究重点和分析单位。当使用收缩压或舒张压阈值来确定纳入试验时,基线变异性显著降低,收缩压从14.0 mmHg降至9.3 mmHg,舒张压从8.4 mmHg降至5.3 mmHg。噻嗪类药物不会改变血压变异性,因为在治疗结束时,噻嗪类药物组和安慰剂组的收缩压和舒张压的标准差及变异系数并无差异。收缩压的变异系数显著大于舒张压的变异系数。纳入标准会降低基线血压变异性。使用噻嗪类利尿剂治疗不影响血压变异性。收缩压的变化程度大于舒张压。