Medicine, Research Institute of the McGill University Health Centre, Montreal, Canada.
Cardiology, Queen Elizabeth Health Complex, Montreal, Canada.
BMJ Open. 2020 Mar 12;10(3):e036128. doi: 10.1136/bmjopen-2019-036128.
Hypertension is a leading cause of mortality worldwide and its prevalence is expected to rise over the next decade. Sex differences exist in the epidemiology and pathophysiology of hypertension. It is well established that antihypertensive treatment can significantly reduce the risk for stroke and other cardiovascular disease events. However, it remains unclear whether this effect is dependent on sex. In this protocol, we outlined a systematic review and meta-analysis to evaluate the effects of antihypertensive therapy in (1) reducing blood pressure and (2) preventing cardiovascular morbidity and mortality outcomes for each sex separately.
The following electronic databases will be searched: Medline, Embase, The Cochrane Library, PubMed, Cumulative Index of Nursing and Allied Health Literature Plus, Web of Science, grey literature (Google Scholar) and several trial registries. Search strategies will be designed to identify human adult (≥18) randomised (and non-randomised) controlled trials, prospective and retrospective cohort studies, and case-control studies concerning 'sex-specific differences associated with the efficacy of antihypertensive treatment'. A preliminary search strategy was developed for Medline (1946-16 September 2019). Two investigators will independently review each article included in the final analysis. Primary outcomes investigated are cardiovascular morbidity and mortality and systolic and diastolic blood pressure. Pooled analyses will be conducted using the random-effects model. Publication bias will be assessed by visual inspection of funnel plots and by Begg's and Egger's statistical tests. Between-studies heterogeneity will be measured using the I test (p<0.10). Sources of heterogeneity will be explored by sensitivity, subgroup and metaregression analyses.
This is the first meta-analysis that will comprehensively compare the efficacy of antihypertensive treatment regimens between men and women. Findings will be shared through scientific conferences and societies, social media and consumer advocacy groups. Results will be used to inform the current guidelines for management of hypertension in men and women by demonstrating the importance of implementing sex-specific recommendations. Ethical considerations are not applicable for this protocol.
高血压是全球范围内导致死亡的主要原因，预计在未来十年内其患病率将会上升。高血压的流行病学和病理生理学存在性别差异。已有研究证实，降压治疗可以显著降低中风和其他心血管疾病事件的风险。然而，目前尚不清楚这种效果是否依赖于性别。在本方案中，我们概述了一项系统评价和荟萃分析，以评估降压治疗在（1）降低血压和（2）预防心血管发病率和死亡率方面对男性和女性的效果。
将对以下电子数据库进行检索：Medline、Embase、The Cochrane Library、PubMed、护理学和联合健康文献累积索引加 Web of Science、灰色文献（Google Scholar）和几个试验注册处。将设计搜索策略以确定与“降压治疗效果的性别特异性差异相关”的人类成年（≥18 岁）随机（和非随机）对照试验、前瞻性和回顾性队列研究以及病例对照研究。已经为 Medline（1946 年至 2019 年 9 月 16 日）制定了初步的搜索策略。两名调查员将独立审查最终分析中包含的每篇文章。主要研究结果为心血管发病率和死亡率以及收缩压和舒张压。将使用随机效应模型进行汇总分析。通过视觉检查漏斗图和 Begg 和 Egger 统计检验评估发表偏倚。通过 I 检验（p<0.10）测量研究间异质性。通过敏感性分析、亚组分析和荟萃回归分析探索异质性来源。
这是首次全面比较降压治疗方案在男性和女性中的疗效的荟萃分析。研究结果将通过科学会议和学会、社交媒体和消费者权益团体进行分享。结果将用于告知目前男性和女性高血压管理指南，通过展示实施性别特异性建议的重要性。本方案不需要进行伦理考虑。
