饮食中补充“鱼油”能否降低血压？一项对照临床试验的荟萃分析。

Does supplementation of diet with 'fish oil' reduce blood pressure? A meta-analysis of controlled clinical trials.

作者信息

Appel L J, Miller E R, Seidler A J, Whelton P K

机构信息

Welch Center for Prevention, Epidemiology, and Clinical Research, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md.

出版信息

Arch Intern Med. 1993 Jun 28;153(12):1429-38.

PMID:8141868

Abstract

BACKGROUND

Several lines of evidence suggest that supplementation of diet with omega-3 polyunsaturated fatty acids (omega-3 PUFA), commonly referred to as fish oils, may reduce blood pressure (BP). However, most clinical trials of omega-3 PUFA supplementation have been of insufficient size to detect relevant BP changes.

METHODS

We conducted a meta-analysis of 17 controlled clinical trials of omega-3 PUFA supplementation. To estimate an overall effect of omega-3 PUFA supplementation on BP, we calculated the net BP change in each trial (BP delta in omega-3 PUFA group minus BP delta in control group), which was then weighted according to the inverse of the variance.

RESULTS

In the 11 trials that enrolled normotensive individuals (n = 728), omega-3 PUFA supplementation led to significant reductions of systolic BP (SBP) and diastolic BP (DBP) in two and one trials, respectively. In the six studies that enrolled untreated hypertensives (n = 291), significant reductions of SBP and DBP were present in two and four trials, respectively. Weighted, pooled estimates of SBP and DBP change (mm Hg) with 95% confidence intervals were -1.0 (-2.0 to 0.0) and -0.5 (-1.2 to +0.2) in the trials of normotensives, and -5.5 (-8.1 to -2.9) and -3.5 (-5.0 to -2.1) in the trials of untreated hypertensives. In 13 of 17 studies, trial duration was less than 3 months. Doses of omega-3 PUFA tended to be high (average dose > 3 g/d in 11 trials). The magnitude of BP reduction was greatest at high BP but was not significantly associated with dose of omega-3 PUFA. Side effects, most commonly eructation and a fishy taste, occurred more frequently in omega-3 PUFA participants than in control participants (28% vs 13%, P < .001).

CONCLUSIONS

Our analyses indicate that diet supplementation with a relatively high dose of omega-3 PUFA, generally more than 3 g/d, can lead to clinically relevant BP reductions in individuals with untreated hypertension. However, use of omega-3 PUFA as antihypertensive therapy will require demonstration of long-term efficacy and patient acceptability of lower doses.

摘要

背景

多项证据表明，在饮食中补充ω-3多不饱和脂肪酸（ω-3 PUFA），通常称为鱼油，可能会降低血压（BP）。然而，大多数关于补充ω-3 PUFA的临床试验规模不足以检测到相关的血压变化。

方法

我们对17项补充ω-3 PUFA的对照临床试验进行了荟萃分析。为了估计补充ω-3 PUFA对血压的总体影响，我们计算了每项试验中的净血压变化（ω-3 PUFA组的血压变化量减去对照组的血压变化量），然后根据方差的倒数进行加权。

结果

在纳入血压正常个体的11项试验（n = 728）中，补充ω-3 PUFA分别在2项和1项试验中导致收缩压（SBP）和舒张压（DBP）显著降低。在纳入未经治疗的高血压患者的6项研究（n = 291）中，分别在2项和4项试验中出现SBP和DBP的显著降低。在血压正常个体的试验中，SBP和DBP变化（mmHg）的加权合并估计值及95%置信区间为-1.0（-2.0至0.0）和-0.5（-1.2至+0.2），在未经治疗的高血压患者的试验中为-5.5（-8.1至-2.9）和-3.5（-5.0至-2.1）。在17项研究中的13项中，试验持续时间少于3个月。ω-3 PUFA的剂量往往较高（11项试验中的平均剂量> 3 g/d）。血压降低幅度在高血压时最大，但与ω-3 PUFA的剂量无显著关联。副作用最常见的是嗳气和鱼腥味，在ω-3 PUFA组参与者中比对照组参与者更频繁出现（28%对13%，P <.001）。