Combined traditional Chinese medicine and anti-hypertensive treatments for renal hypertension: A network meta-analysis and systematic review.

BACKGROUND

Traditional Chinese medicine (TCM) demonstrates significant effects on renal function, yet it remains unclear which TCM treatment yields the best clinical outcomes for renal hypertension (RH) management. This study aims to evaluate the safety and effectiveness of various TCM treatments for RH compared to conventional Western medicine (CWM).

METHODS

Randomized controlled trials (RCTs) of TCM for RH were screened from 9 databases, covering the period up to July 2023. The Cochrane Risk of Bias tool was utilized to assess the risk of bias in the included RCTs. Network meta-analysis was conducted using RevMan 5.3 and Stata 14.0 software. Sensitivity analyses and meta-regression were performed to identify sources of heterogeneity and assess result robustness.

RESULTS

This study encompassed 3879 patients from 44 investigations involving 29 TCM interventions. The quality of the studies ranged from moderate to excellent, with well-defined inclusion criteria and generally low potential for biases related to outcome data and selective reporting. Tianma Gouteng Yin combined with Qiju Dihuang Wan + CWM demonstrated the highest total effective rate (relative risk = 1.31, 95% confidence interval (CI): 1.03, 1.66) compared to CWM alone. Bailing capsule + CWM was optimal for improving serum creatinine (mean difference (MD) = -53.78, 95% CI: -96.59, -10.98). Ziyin Pinggan Huayu decoction + CWM had the highest likelihood (surface under the cumulative ranking curves = 56.2%) of improving blood urea nitrogen. Zishen Pinggan prescription + CWM showed the greatest improvement in systolic blood pressure (MD = -46.29, 95% CI: -73.19, -19.38), while Ye Ren Gao decoction + CWM demonstrated the best improvement in diastolic blood pressure (MD = -13.13, 95% CI: -20.12, -6.13). Xifeng Qingnao decoction + CWM achieved the best improvement in 24-hour urinary protein (MD = -2.00, 95% CI: -3.26, -0.74). The combination of TCM and CWM was associated with a lower incidence of adverse effects.

CONCLUSION

Combination therapy of TCM with CWM surpasses CWM alone in treating renal hypertension. This study identifies the most effective combination treatment for RH, as well as optimal treatments for lowering blood pressure (Zishen Pinggan prescription + CWM) and improving renal function (Bailing capsule + CWM).