Chen Ziwen, Xu Tao, Shu Yun-Jie, Zhou Xueli, Li Qifu, Guo Taipin, Liang Fan-Rong
Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China.
School of Second Clinical Medicine/The Second Affiliated Hospital, Yunnan University of Chinese Medicine, Kunming, Yunnan, China
BMJ Open. 2025 Jan 21;15(1):e079360. doi: 10.1136/bmjopen-2023-079360.
Primary hypertension (PH) affects over one billion individuals globally, yet less than 30% achieve controlled blood pressure (BP) with medication. Many patients require a combination of multiple medications to reach targets, but adverse effects and financial burdens undermine adherence. Additionally, prehypertension affects 25%-50% of adults, increasing the risk of cardiovascular complications. Early detection and management of prehypertension are crucial for delaying the need for pharmacological interventions. In recent years, clinical guidelines have increasingly emphasised non-pharmacological interventions for PH management. However, the diversity of non-pharmacological therapies and the inconsistencies in efficacy challenge clinical decision-making. This study aims to use network meta-analysis (NMA) to synthesise existing evidence on non-pharmacological interventions for PH, offering updated clinical insights and evidence-based support to optimise treatment strategies. It will also provide recommendations for integrating these interventions into community-based chronic disease management.
To identify potentially relevant randomised controlled trials, a reverse search strategy will be employed to ascertain all non-pharmacological interventions for PH. A well-constructed search strategy will be applied across nine academic databases (Web of Science, Embase, PubMed, PsycINFO, CENTRAL, AMED, CNKI, WF and VIP database) and three clinical trial registries (WHO ICTRP, ClinicalTrials.gov and ChiCTR) for studies conducted between 1 January 2014 and 1 August 2024. Two investigators will independently extract information from eligible articles and document reasons for exclusions. The primary outcomes will encompass changes in systolic and diastolic BP. Pairwise and Bayesian NMA will be conducted using 'meta' and 'GeMTC' package (R 4.4.1). Risk of bias will be assessed using the Risk of Bias 2 tool, and the quality of evidence will be evaluated according to the Grading of Recommendations, Assessment, Development and Evaluation approach.
As this review involves secondary analysis of previously published data, ethical approval is not required. The results will be published in peer-reviewed journals.
CRD42023451073.
原发性高血压（PH）在全球影响着超过10亿人，但通过药物治疗实现血压控制（BP）的患者不到30%。许多患者需要联合使用多种药物才能达到目标，但不良反应和经济负担会削弱依从性。此外，血压正常高值影响25%-50%的成年人，增加了心血管并发症的风险。早期发现和管理血压正常高值对于推迟药物干预的需求至关重要。近年来，临床指南越来越强调原发性高血压管理的非药物干预。然而，非药物疗法的多样性和疗效的不一致性对临床决策提出了挑战。本研究旨在使用网络荟萃分析（NMA）来综合现有关于原发性高血压非药物干预的证据，提供最新的临床见解和循证支持以优化治疗策略。它还将为将这些干预措施纳入社区慢性病管理提供建议。
为识别潜在相关的随机对照试验，将采用反向检索策略来确定所有针对原发性高血压的非药物干预措施。将精心构建的检索策略应用于九个学术数据库（科学网、Embase、PubMed、PsycINFO、CENTRAL、AME D、中国知网、万方数据库和维普数据库）和三个临床试验注册库（世界卫生组织国际临床试验注册平台、ClinicalTrials.gov和中国临床试验注册中心），以查找2014年1月1日至2024年8月1日期间开展的研究。两名研究人员将独立从符合条件的文章中提取信息，并记录排除原因。主要结局将包括收缩压和舒张压的变化。将使用“meta”和“GeMTC”软件包（R 4.4.1）进行成对和贝叶斯网络荟萃分析。将使用偏倚风险2工具评估偏倚风险，并根据推荐分级、评估、制定和评价方法评估证据质量。
由于本综述涉及对先前发表数据的二次分析，因此无需伦理批准。研究结果将发表在同行评审期刊上。
PROSPERO注册号：CRD42023451073。
