Xiong Xing-Jiang, Wang Peng-Qian, Li Sheng-Jie
Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China.
Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, China.
Chin J Integr Med. 2019 Feb;25(2):139-146. doi: 10.1007/s11655-018-3009-2. Epub 2018 Jun 25.
To evaluate the efficacy and safety of blood-letting therapy (BLT) in treatment of hypertension.
A comprehensive electronic and manual bibliographic searches were performed in Cochrane Central Register of Controlled Trials, Excerpt Medica Database (EMBASE), PubMed, China National Knowledge Infrastructure, Chinese Scientific Journal Database, Chinese Biomedical Literature Database, and Wanfang Database to identify randomized controlled trials (RCTs) in which hypertensive patients were treated with BLT or BLT plus antihypertensive drugs (BPAD) against placebo, no treatment or antihypertensive drugs. The Cochrane Risk Assessment Tool was used to assess the methodological quality of trials. The Review Manager 5.3 software was used for meta-analysis.
A total of 7 RCTs with 637 hypertensive patients from 1989 to 2017 were identified. Compared with antihypertensive drugs, blood pressure was significantly reduced by BLT (RR=1.21, 95% CI: 1.01 to 1.44, P=0.03; heterogeneity: P=0.06, I=60%) and BPAD (RR=1.25, 95% CI, 1.02 to 1.53, P=0.03; heterogeneity: P= 0.01, I=71%). Moreover, a significant improvement in Chinese medicine syndrome by BLT (RR=1.32; 95% CI: 1.14 to 1.53, P=0.0002; heterogeneity: P=0.53, I=0%) and BPAD (RR=1.47; 95% CI: 1.06 to 2.04, P=0.02; heterogeneity: P=0.13, I=56%) was identified. The reported adverse effects were well tolerated.
Although some positive findings were identified, no definite conclusions regarding the efficacy and safety of BLT as complementary and alternative approach for treatment of hypertension could be drew due to the generally poor methodological design, significant heterogeneity, and insufficient clinical data. Further rigorously designed trials are warranted to confirm the results.
评估放血疗法（BLT）治疗高血压的疗效和安全性。
在Cochrane对照试验中央注册库、医学文摘数据库（EMBASE）、PubMed、中国知网、中国科学期刊数据库、中国生物医学文献数据库和万方数据库中进行全面的电子和手工文献检索，以识别将高血压患者用放血疗法或放血疗法加抗高血压药物（BPAD）与安慰剂、不治疗或抗高血压药物进行对照的随机对照试验（RCT）。使用Cochrane风险评估工具评估试验的方法学质量。使用Review Manager 5.3软件进行荟萃分析。
共识别出1989年至2017年的7项RCT，涉及637例高血压患者。与抗高血压药物相比，放血疗法（RR=1.21，95%CI：1.01至1.44，P=0.03；异质性：P=0.06，I²=60%）和放血疗法加抗高血压药物（RR=1.25，95%CI：1.02至1.53，P=0.03；异质性：P=0.01，I²=）显著降低了血压。此外，放血疗法（RR=1.32；95%CI：1.14至1.53，P=0.0002；异质性：P=0.53，I²=0%）和放血疗法加抗高血压药物（RR=1.47；95%CI：1.06至2.04，P=0.02；异质性：P=0.13，I²=56%）使中医证候有显著改善。报告的不良反应耐受性良好。
尽管发现了一些阳性结果，但由于方法学设计普遍较差、显著的异质性和临床数据不足，关于放血疗法作为高血压补充和替代治疗方法的疗效和安全性无法得出明确结论。需要进一步进行严格设计的试验来证实结果。
