降压治疗的效果正在减弱吗？：Meta回归分析
Are the effects of blood pressure lowering treatment diminishing?: meta-regression analyses.
作者信息
Sekizawa Yoichi, Konishi Yoko, Kimura Moriyo
机构信息
1Research Institute of Economy, Trade and Industry, 1-3-1 Kasumigaseki Chiyoda-ku, Tokyo, 100-8901 Japan.
The Public Health Institute, 3-3-23-104, Sendagaya Shibuya-ku, Tokyo, 151-0051 Japan.
出版信息
Clin Hypertens. 2018 Nov 15;24:16. doi: 10.1186/s40885-018-0101-9. eCollection 2018.
BACKGROUND
Previous studies have suggested that the effects of medical interventions tend to diminish over time. We investigated whether the effects of blood pressure lowering treatment on all-cause mortality and stroke have diminished over time.
METHODS
We conducted meta-regression analyses. We extracted the target trials from two recently published comprehensive systematic reviews and meta-analyses. Adopted variables were relative risk (RR) of all-cause mortality and stroke, trial start year, mean age, sample size, baseline systolic blood pressure (SBP), difference in attained SBP reduction between intervention groups and control groups (SBP difference), and regional dummies. We implemented single meta-regressions, in which the dependent variable was the log of RR and the explanatory variable was each of other adopted variables. We also conducted multiple meta-regressions, in which the dependent variable was the log of RR and explanatory variables were all of other adopted variables. Our variable of greatest interest was trial start year.
RESULTS
The included reviews assessed 85 trials with a total of 343,126 participants. Although trial start year was positively associated with the log of RR in the results of single meta-regressions, it lost significance in multiple meta-regressions for both all-cause mortality and stroke.
CONCLUSIONS
The effects of blood pressure lowering treatment on all-cause mortality and stroke have not diminished over time.
背景
既往研究表明，医学干预的效果往往会随着时间推移而减弱。我们调查了降压治疗对全因死亡率和中风的影响是否随时间而减弱。
方法
我们进行了meta回归分析。我们从最近发表的两项全面的系统评价和meta分析中提取目标试验。采用的变量包括全因死亡率和中风的相对风险（RR）、试验开始年份、平均年龄、样本量、基线收缩压（SBP）、干预组与对照组之间实现的SBP降低差异（SBP差异）以及地区虚拟变量。我们进行了单因素meta回归，其中因变量是RR的对数，解释变量是其他每个采用的变量。我们还进行了多因素meta回归，其中因变量是RR的对数，解释变量是所有其他采用的变量。我们最感兴趣的变量是试验开始年份。
结果
纳入的评价评估了85项试验，共343126名参与者。虽然在单因素meta回归结果中试验开始年份与RR的对数呈正相关，但在全因死亡率和中风的多因素meta回归中它失去了显著性。
结论
降压治疗对全因死亡率和中风的影响并未随时间而减弱。
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