运动和降压药物对血压的综合影响是否等于它们各自影响的总和？一项系统的Meta综述。
Do the combined blood pressure effects of exercise and antihypertensive medications add up to the sum of their parts? A systematic meta-review.
作者信息
Pescatello Linda S, Wu Yin, Gao Simiao, Livingston Jill, Sheppard Bonny Bloodgood, Chen Ming-Hui
机构信息
Department of Kinesiology, University of Connecticut, Storrs, Connecticut, USA.
Department of Statistics, University of Connecticut, Storrs, Connecticut, USA.
出版信息
BMJ Open Sport Exerc Med. 2021 Jan 20;7(1):e000895. doi: 10.1136/bmjsem-2020-000895. eCollection 2021.
OBJECTIVE
To compare the blood pressure (BP) effects of exercise alone (EXalone), medication alone (MEDSalone) and combined (EX+MEDScombined) among adults with hypertension.
DATA SOURCES
PubMed, Scopus, Cumulative Index to Nursing and Allied Health Literature, SPORTDiscus and the Cochrane Library.
ELIGIBILITY CRITERIA
Randomised controlled trails (RCTs) or meta-analyses (MAs) of controlled trials that: (1) involved healthy adults>18 year with hypertension; (2) investigated exercise and BP; (3) reported preintervention and postintervention BP and (4) were published in English. RCTs had an EX+MEDScombined arm; and an EXalone arm and/or an MEDSalone arm; and MAs performed moderator analyses.
DESIGN
A systematic network MA and meta-review with the evidence graded using the Physical Activity Guidelines for Americans Advisory Committee system.
OUTCOME
The BP response for EXalone, MEDSalone and EX+MEDScombined and compared with each other.
RESULTS
Twelve RCTs qualified with 342 subjects (60% women) who were mostly physically inactive, middle-aged to older adults. There were 13 qualifying MAs with 28 468 participants (~50% women) who were mostly Caucasian or Asian. Most RCTs were aerobic (83.3%), while the MAs involved traditional (46%) and alternative (54%) exercise types. Strong evidence demonstrates EXalone, MEDSalone and EX+MEDScombined reduce BP and EX+MEDScombined elicit BP reductions less than the sum of their parts. Strong evidence indicates EX+MEDScombined potentiate the BP effects of MEDSalone. Although the evidence is stronger for alternative than traditional types of exercise, EXaloneelicits greater BP reductions than MEDSalone.
CONCLUSIONS
The combined BP effects of exercise and medications are not additive or synergistic, but when combined they bolster the antihypertensive effects of MEDSalone.
PROSPERO REGISTRATION NUMBER
The protocol is registered at PROSPERO CRD42020181754.
目的
比较单独运动（EXalone）、单独药物治疗（MEDSalone）以及联合治疗（EX + MEDScombined）对高血压成人患者血压（BP）的影响。
数据来源
PubMed、Scopus、护理学与健康相关文献累积索引、SPORTDiscus以及Cochrane图书馆。
纳入标准
随机对照试验（RCT）或对照试验的荟萃分析（MA），满足以下条件：（1）纳入年龄大于18岁的高血压健康成人；（2）研究运动与血压；（3）报告干预前和干预后的血压；（4）以英文发表。RCT需有EX + MEDScombined组，以及EXalone组和/或MEDSalone组；MA需进行调节分析。
设计
一项系统网络MA和荟萃综述，采用美国身体活动指南咨询委员会系统对证据进行分级。
结果
12项RCT符合要求，共342名受试者（60%为女性），大多为身体活动不足的中老年人。有13项符合要求的MA，共28468名参与者（约50%为女性），大多为白种人或亚洲人。大多数RCT为有氧运动（83.3%），而MA涉及传统运动类型（46%）和替代运动类型（54%）。有力证据表明，EXalone、MEDSalone和EX + MEDScombined均可降低血压，且EX + MEDScombined引起的血压降低幅度小于其各部分之和。有力证据表明，EX + MEDScombined可增强MEDSalone的血压降低效果。尽管替代运动类型的证据比传统运动类型更强，但EXalone引起的血压降低幅度大于MEDSalone。
结论
运动和药物联合对血压的影响并非相加或协同作用，但联合使用时可增强MEDSalone的降压效果。
PROSPERO注册号：该方案已在PROSPERO注册，注册号为CRD42020181754。
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