Gibbon Jake Ryan, Frith James
Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK.
Clin Auton Res. 2021 Aug;31(4):499-509. doi: 10.1007/s10286-021-00814-5. Epub 2021 Jun 18.
To systematically review the evidence base for the effectiveness and safety of caffeine for the treatment of neurogenic orthostatic hypotension in adults.
Eight electronic databases were searched in January 2021. Original research studies or case reports involving adults with neurogenic orthostatic hypotension were included if caffeine was an intervention and outcomes included symptoms, blood pressure or adverse effects. Relevant studies were screened and underwent qualitative analysis. Insufficient reporting precluded meta-analysis.
Five studies were identified: four crossover studies and one case report summation. Study size ranged from 5 to 16 participants. Participants had neurogenic orthostatic hypotension, with a mean standing systolic blood pressure of 86 mmHg. Two studies evaluated caffeine alone. Three studies administered caffeine in combination with ergotamine. Caffeine dose ranged from 100 to 300 mg. Nature and timing of outcomes measured varied between studies, with measurements being recorded from 30 to 480 min after intervention. Caffeine/ergotamine improved symptoms in one study and reduced orthostatic blood pressure drop in two studies. Caffeine/ergotamine increased seated blood pressure in three studies, whilst the results for caffeine alone were inconsistent. No serious adverse events were reported. All studies demonstrated high risk of bias.
Caffeine should only be considered as a treatment for adults with neurogenic orthostatic hypotension when evidence-based treatments have been exhausted.
PROSPERO ID: CRD42020124589. Date of registration: 30/10/2020.
系统评价咖啡因治疗成人神经源性直立性低血压有效性和安全性的证据基础。
于2021年1月检索了8个电子数据库。纳入以咖啡因作为干预措施且结局包括症状、血压或不良反应的涉及成人神经源性直立性低血压的原始研究或病例报告。对相关研究进行筛选并进行定性分析。报告不足无法进行荟萃分析。
共确定5项研究：4项交叉研究和1项病例报告汇总。研究样本量为5至16名参与者。参与者患有神经源性直立性低血压，平均站立收缩压为86 mmHg。2项研究单独评估咖啡因。3项研究将咖啡因与麦角胺联合使用。咖啡因剂量为100至300 mg。各研究测量结局的性质和时间不同，干预后30至480分钟记录测量结果。在1项研究中，咖啡因/麦角胺改善了症状，在2项研究中降低了直立性血压下降。在3项研究中，咖啡因/麦角胺增加了坐位血压，而单独使用咖啡因的结果不一致。未报告严重不良事件。所有研究均显示存在高偏倚风险。
只有在循证治疗手段均无效时，才应考虑将咖啡因用于治疗成人神经源性直立性低血压。
PROSPERO注册号：CRD42020124589。注册日期：2020年10月30日。
