Liu Chun-Ting, Hung I-Ling, Hsu Chung Y, Hu Kai-Chieh, Chen Yung-Hsiang, Tsai Ming-Yen
Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan.
Front Cardiovasc Med. 2022 Jul 11;9:922728. doi: 10.3389/fcvm.2022.922728. eCollection 2022.
Hypertension (HTN) is the leading preventable risk factor for cardiovascular disease worldwide. Patients with HTN are at higher risk for heart failure (HF). The currently available therapeutic approaches for HTN do not always optimally control blood pressure or are not suitable for hypertensive patients who have a higher number of comorbidities. This study aimed to determine whether Chinese herbal medicine (CMH)-based interventions could reduce the risk of HF in hypertensive patients.
This retrospective study randomly selected 2 million enrollees from the National Health Insurance Research Database and identified 507,608 patients who were newly diagnosed with HTN in 2000-2017. After 1:1 frequency-matching by age, sex, index year, income, urbanization, duration of HTN, comorbidities and antihypertensive medications, we selected 8,912 eligible patients in each group. During 16 years of follow-up, 380 CHM users and 426 CHM non-users developed HF, representing incidence rates of 6.29 and 7.43 per 1,000 person-years, respectively.
CHM users had significantly lower HF risk compared with CHM non-users (adjusted HR = 0.85, 95% CI 0.74-0.98). The markedly predominant effect was observed in those receiving CHM products for more than 180 days (adjusted HR = 0.65). The frequently prescribed formula, Jia-Wei-Xiao-Yao-San, and the single herbs Ge Gen, Huang Qi, Du Zhong, Huang Qin, and Chuan Xiong were significantly associated with lower risk of HF.
This population-based study revealed decreased HF risk in hypertensive patients with CHM use. These findings may provide a reference for HF prevention strategies and support the integration of CHM into clinical intervention programs that provide a favorable prognosis for hypertensive patients.
高血压是全球心血管疾病首要的可预防风险因素。高血压患者发生心力衰竭的风险更高。目前可用的高血压治疗方法并不总能最佳地控制血压，或者不适用于合并症较多的高血压患者。本研究旨在确定基于中草药的干预措施是否可以降低高血压患者发生心力衰竭的风险。
这项回顾性研究从国民健康保险研究数据库中随机选取了200万名参与者，并确定了2000年至2017年新诊断为高血压的507,608名患者。在按年龄、性别、索引年份、收入、城市化程度、高血压病程、合并症和抗高血压药物进行1:1频率匹配后，我们在每组中选择了8912名符合条件的患者。在16年的随访期间，380名使用中草药的患者和426名未使用中草药的患者发生了心力衰竭，发病率分别为每1000人年6.29例和7.43例。
与未使用中草药的患者相比，使用中草药的患者发生心力衰竭的风险显著降低（调整后的风险比=0.85，95%置信区间0.74-0.98）。在接受中草药产品治疗超过180天的患者中观察到显著的主要效果（调整后的风险比=0.65）。常用方剂逍遥散加味以及单味药葛根、黄芪、杜仲、黄芩和川芎与较低的心力衰竭风险显著相关。
这项基于人群的研究表明，使用中草药的高血压患者发生心力衰竭的风险降低。这些发现可能为心力衰竭预防策略提供参考，并支持将中草药纳入可为高血压患者提供良好预后的临床干预方案。
