Wang Lin, Liu Qingqing, Sun Dongsheng, Xie Jianhong, Lao Dibo, Zhang Li
Heart Center, Department of Geriatrics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, People's Republic of China.
Department of Respiratory and Critical Care Medicine, Shulan (Hangzhou) Hospital, Hangzhou, Zhejiang, People's Republic of China.
Ther Clin Risk Manag. 2022 Mar 5;18:197-211. doi: 10.2147/TCRM.S347622. eCollection 2022.
Hypertension commonly co-exists with depression and is associated with adverse health outcomes. This meta-analysis aimed to examine whether combination treatment can improve the outcomes of patients with comorbid hypertension and depression.
We searched for relevant randomized controlled trials (RCTs) published through July 2021 using PubMed, Web of Science, China National Knowledge Infrastructure, and Wanfang Data. RCTs on patients with an antihypertensive outcome and data on mean blood pressure differences were extracted for both intervention and control groups. Continuous and dichotomous measures of outcomes were pooled using weighted mean differences (WMD) and risk ratios (RR) with 95% confidence intervals (CI) by random or fixed effects. Subgroup and meta-regression analyses were performed to identify any existing heterogeneous sources.
A total of 27 RCTs with 2606 participants were included. Combination treatment significantly improved systolic blood pressure (SBP) by 11.27 mmHg (WMD = -11.27, 95% CI: -14.12 to -8.43), I = 95.4%), diastolic blood pressure (DBP) by 8.21 mmHg (WMD = -8.21, 95% CI: -10.73 to -5.69), I = 96.9%), and antihypertensive efficiency by 42% (RR = 1.42, 95% CI: 1.32 to 1.52, I = 0.0%) compared with in the control group. Combination treatment improved SBP and DBP levels in patients aged <65 years compared with those in patients aged ≥65 years (p = 0.020 and 0.007, respectively).
Pooled evidence suggests that combination treatment significantly improves both blood pressure levels and antihypertensive efficiency in hypertensive patients with depression. Elderly patients with comorbid hypertension and depression may require a more collaborative approach to improve their outcome.
PROSPERO registration number CRD42020213430. Registered on November 08, 2020.
高血压常与抑郁症共存，并与不良健康结局相关。本荟萃分析旨在探讨联合治疗是否能改善合并高血压和抑郁症患者的结局。
我们使用PubMed、Web of Science、中国知网和万方数据检索截至2021年7月发表的相关随机对照试验（RCT）。提取干预组和对照组中关于降压结局的RCT以及平均血压差异数据。采用加权均数差（WMD）和风险比（RR）合并连续和二分结局指标，并计算95%置信区间（CI），采用随机效应或固定效应模型。进行亚组分析和Meta回归分析以识别任何现有的异质性来源。
共纳入27项RCT，2606名参与者。与对照组相比，联合治疗显著降低收缩压（SBP）11.27 mmHg（WMD = -11.27，95%CI：-14.12至-8.43，I² = 95.4%），舒张压（DBP）8.21 mmHg（WMD = -8.21，95%CI：-10.73至-5.69，I² = 96.9%），降压有效率提高42%（RR = 1.42，95%CI：1.32至1.52，I² = 0.0%）。与≥65岁患者相比，联合治疗改善了<65岁患者的SBP和DBP水平（p分别为0.020和0.007）。
汇总证据表明，联合治疗显著改善了合并抑郁症的高血压患者的血压水平和降压有效率。老年合并高血压和抑郁症患者可能需要更协同的方法来改善其结局。
PROSPERO注册号CRD42020213430。于2020年11月8日注册。
