非药物干预对全球高血压人群的短期疗效：一项网络荟萃分析。
Short-term efficacy of non-pharmacological interventions for global population with elevated blood pressure: A network meta-analysis.
机构信息
Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, China.
Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.
出版信息
Front Public Health. 2023 Jan 13;10:1051581. doi: 10.3389/fpubh.2022.1051581. eCollection 2022.
BACKGROUND
This study aims to compare the potential short-term effects of non-pharmacological interventions (NPIs) on prehypertensive people, and provide evidence for intervention models with potential in future community-based management.
METHODS
In this Bayesian network meta-analysis, Pubmed, Embase, and Web of science were screened up to 16 October 2021. Prehypertensive patients (systolic blood pressure, SBP 120-139 mmHg/diastolic blood pressure, DBP 80-89 mmHg) with a follow-up period longer than 4 weeks were targeted. Sixteen NPIs were identified during the scope review and categorized into five groups. Reduction in SBP and DBP was selected as outcome variables and the effect sizes were compared using consistency models among interventions and intervention groups. Grade approach was used to assess the certainty of evidence.
RESULTS
Thirty-nine studies with 8,279 participants were included. For SBP, strengthen exercises were the most advantageous intervention group when compared with usual care (mean difference = -6.02 mmHg, 95% CI -8.16 to -3.87), and combination exercise, isometric exercise, and aerobic exercise were the three most effective specific interventions. For DBP, relaxation was the most advantageous intervention group when compared with usual care (mean difference = -4.99 mmHg, 95% CI -7.03 to -2.96), and acupuncture, meditation, and combination exercise were the three most effective specific interventions. No inconsistency was found between indirect and direct evidence. However, heterogeneity was detected in some studies.
CONCLUSION
NPIs can bring short-term BP reduction benefits for prehypertensive patients, especially exercise and relaxation. NPIs could potentially be included in community-based disease management for prehypertensive population once long-term real-world effectiveness and cost-effectiveness are proven.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=151518, identifier: CRD42020151518.
背景
本研究旨在比较非药物干预（NPIs）对高血压前期人群的潜在短期影响，并为未来基于社区的管理中具有潜在应用价值的干预模式提供证据。
方法
在这项贝叶斯网络荟萃分析中，我们对 Pubmed、Embase 和 Web of science 进行了筛选，截至 2021 年 10 月 16 日。研究对象为随访时间超过 4 周的高血压前期患者（收缩压 120-139mmHg/舒张压 80-89mmHg）。在范围审查过程中确定了 16 种 NPIs，并将其分为五组。以收缩压和舒张压的降低为观察指标，采用一致性模型比较各干预措施和干预组之间的效应量。采用等级方法评估证据的确定性。
结果
共纳入 39 项研究，8279 名参与者。对于收缩压，与常规护理相比，强化运动是最有利的干预组（平均差值=-6.02mmHg，95%CI-8.16 至-3.87），而组合运动、等长运动和有氧运动是三种最有效的特定干预措施。对于舒张压，与常规护理相比，放松是最有利的干预组（平均差值=-4.99mmHg，95%CI-7.03 至-2.96），而针灸、冥想和组合运动是三种最有效的特定干预措施。间接证据与直接证据之间没有不一致。然而，一些研究中存在异质性。
结论
NPIs 可使高血压前期患者的血压在短期内得到降低，尤其是运动和放松。一旦证明 NPIs 在高血压前期人群中的长期真实世界疗效和成本效益，它们可能被纳入社区为基础的疾病管理。
系统评价注册
https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=151518，识别码：CRD42020151518。
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