Blood-Letting Therapy for Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
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摘要
Objective:To evaluate the efficacy and safety of blood-letting therapy(BLT)in treatment of hypertension.Methods:A comprehensive electronic and manual bibliographic searches were performed in Cochrane Central Register of Controlled Trials,Excerpt Medica Database(EMBASE),PubMed,China National Knowledge Infrastructure,Chinese Scientific Journal Database,Chinese Biomedical Literature Database,and Wanfang Database to identify randomized controlled trials(RCTs)in which hypertensive patients were treated with BLT or BLT plus antihypertensive drugs(BPAD)against placebo,no treatment or antihypertensive drugs.The Cochrane Risk Assessment Tool was used to assess the methodological quality of trials.The Review Manager 5.3 software was used for meta-analysis.Results:A total of 7 RCTs with 637 hypertensive patients from 1989 to 2017 were identified.Compared with antihypertensive drugs,blood pressure was significantly reduced by BLT(RR=1.21,95%CI:1.01 to 1.44,P=0.03;heterogeneity:P=0.06,I~2=60%)and BPAD(RR=1.25,95%CI,1.02 to 1.53,P=0.03;heterogeneity:P=0.01,I~2=71%).Moreover,a significant improvement in Chinese medicine syndrome by BLT(RR=1.32;95%CI:1.14 to 1.53,P=0.0002;heterogeneity:P=0.53,I~2=0%)and BPAD(RR=1.47;95%CI:1.06 to 2.04,P=0.02;heterogeneity:P=0.13,I~2=56%)was identified.The reported adverse effects were well tolerated.Conclusions:Although some positive findings were identified,no definite conclusions regarding the efficacy and safety of BLT as complementary and alternative approach for treatment of hypertension could be drew due to the generally poor methodological design,significant heterogeneity,and insufficient clinical data.Further rigorously designed trials are warranted to confirm the results.
Objective:To evaluate the efficacy and safety of blood-letting therapy(BLT)in treatment of hypertension.Methods:A comprehensive electronic and manual bibliographic searches were performed in Cochrane Central Register of Controlled Trials,Excerpt Medica Database(EMBASE),PubMed,China National Knowledge Infrastructure,Chinese Scientific Journal Database,Chinese Biomedical Literature Database,and Wanfang Database to identify randomized controlled trials(RCTs)in which hypertensive patients were treated with BLT or BLT plus antihypertensive drugs(BPAD)against placebo,no treatment or antihypertensive drugs.The Cochrane Risk Assessment Tool was used to assess the methodological quality of trials.The Review Manager 5.3 software was used for meta-analysis.Results:A total of 7 RCTs with 637 hypertensive patients from 1989 to 2017 were identified.Compared with antihypertensive drugs,blood pressure was significantly reduced by BLT(RR=1.21,95%CI:1.01 to 1.44,P=0.03;heterogeneity:P=0.06,I~2=60%)and BPAD(RR=1.25,95%CI,1.02 to 1.53,P=0.03;heterogeneity:P=0.01,I~2=71%).Moreover,a significant improvement in Chinese medicine syndrome by BLT(RR=1.32;95%CI:1.14 to 1.53,P=0.0002;heterogeneity:P=0.53,I~2=0%)and BPAD(RR=1.47;95%CI:1.06 to 2.04,P=0.02;heterogeneity:P=0.13,I~2=56%)was identified.The reported adverse effects were well tolerated.Conclusions:Although some positive findings were identified,no definite conclusions regarding the efficacy and safety of BLT as complementary and alternative approach for treatment of hypertension could be drew due to the generally poor methodological design,significant heterogeneity,and insufficient clinical data.Further rigorously designed trials are warranted to confirm the results.
Objective:To evaluate the efficacy and safety of blood-letting therapy(BLT)in treatment of hypertension.Methods:A comprehensive electronic and manual bibliographic searches were performed in Cochrane Central Register of Controlled Trials,Excerpt Medica Database(EMBASE),PubMed,China National Knowledge Infrastructure,Chinese Scientific Journal Database,Chinese Biomedical Literature Database,and Wanfang Database to identify randomized controlled trials(RCTs)in which hypertensive patients were treated with BLT or BLT plus antihypertensive drugs(BPAD)against placebo,no treatment or antihypertensive drugs.The Cochrane Risk Assessment Tool was used to assess the methodological quality of trials.The Review Manager 5.3 software was used for meta-analysis.Results:A total of 7 RCTs with 637 hypertensive patients from 1989 to 2017 were identified.Compared with antihypertensive drugs,blood pressure was significantly reduced by BLT(RR=1.21,95%CI:1.01 to 1.44,P=0.03;heterogeneity:P=0.06,I~2=60%)and BPAD(RR=1.25,95%CI,1.02 to 1.53,P=0.03;heterogeneity:P=0.01,I~2=71%).Moreover,a significant improvement in Chinese medicine syndrome by BLT(RR=1.32;95%CI:1.14 to 1.53,P=0.0002;heterogeneity:P=0.53,I~2=0%)and BPAD(RR=1.47;95%CI:1.06 to 2.04,P=0.02;heterogeneity:P=0.13,I~2=56%)was identified.The reported adverse effects were well tolerated.Conclusions:Although some positive findings were identified,no definite conclusions regarding the efficacy and safety of BLT as complementary and alternative approach for treatment of hypertension could be drew due to the generally poor methodological design,significant heterogeneity,and insufficient clinical data.Further rigorously designed trials are warranted to confirm the results.
引文
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2.James PA,Oparil S,Carter BL,et al.2014 evidence-based guideline for the management of high blood pressure in adults report from the panel members appointed to the Eighth Joint National Committee(JNC8).J Am Med Assoc2014;311:507-520.
3.Mancia G,Fagard R,Narkiewicz K,et al.2013 ESH/ESCguidelines for the management of arterial hypertension:the task force for the management of arterial hypertension of the European Society of Hypertension(ESH)and the European Society of Cardiology(ESC).Eur Heart J2013;34:2159-2219.
4.Chow CK,Teo KK,Rangarajan S,et al.Prevalence,awareness,treatment,and control of hypertension in rural and urban communities in high-,middle-,and low-income countries.J Am Med Assoc 2013;310:959-968.
5.Guo F,He D,Zhang W,et al.Trends in prevalence,awareness,management,and control of hypertension among United States adults,1999 to 2010.J Am Coll Cardiol 2012;60:599-606.
6.Bauchner H,Fontanarosa PB,Golub RM.Updated guidelines for management of high blood pressure:recommendations,review,and responsibility.J Am Med Assoc 2014;311:477-478.
7.Xiong XJ.Integrating traditional Chinese medicine into Western cardiovascular medicine:an evidence-based approach.Nat Rev Cardiol 2015;12:e374.
8.Vora CK,Mansoor GA.Herbs and alternative therapies:relevance to hypertension and cardiovascular diseases.Curr Hypertens Rep 2005;7:275-280.
9.Xiong X,Borrelli F,de SáFerreira A,et al.Herbal medicines for cardiovascular diseases.Evid Based Complement Alternat Med 2014;2014:e809741.
10.Brook RD,Appel L J,Rubenfire M,et al.Beyond medications and diet:alternative approaches to lowering blood pressure.Hypertension 2013;61:1360-1383.
11.Xiong XJ,Yang XC,Liu YM,et al.Chinese herbal formulas for treating hypertension in traditional Chinese medicine:perspective of modern science.Hypertens Res2013;36:570-579.
12.Xiong XJ,Liu W,Yang XC,et al.Ginkgo biloba extract for essential hypertension:a systemic review.Phytomedicine2014;21:1131-1136.
13.Xiong XJ,Wang PQ,Li SJ,et al.Garlic for hypertension:a systematic review and meta-analysis of randomized controlled trials.Phytomedicine 2015;32:352-361.
14.Flachskampf FA,Gallasch J,Gefeller O,et al.Randomized trial of acupuncture to lower blood pressure.Circulation2007;115:3121-3129.
15.Xiong XJ,Liu W,Yang XC,et al.Moxibustion for essential hypertension.Complement Ther Med 2014;22:187-195.
16.Xiong XJ,Li SJ,Zhang YQ.Massage therapy for essential hypertension:a systematic review.J Hum Hypertens2015;29:143-151.
17.Goertz CH,Grimm RH,Svendsen K,et al.Treatment of hypertension with alternative therapies(THAT)study:a randomized clinical trial.J Hypertens 2002;20:2063-2068.
18.Xiong X,Wang P,Li X,et al.Qigong for hypertension:a systematic review.Medicine 2015;94:e352.
19.Posadzki P,Cramer H,Kuzdzal A,et al.Yoga for hypertension:a systematic review of randomized clinical trials.Complement Ther Med 2014;22:511-522.
20.Wang J,Feng B,Yang X,et al.Tai Chi for essential hypertension.Evid-Based Complement Alternat Med2013;2013:e215254.
21.Hur MH,Lee MS,Kim C,et al.Aromatherapy for treatment of hypertension:a systematic review.J Eval Clin Pract2012;18:37-41.
22.Yang HX.Clinical application of blood-letting therapy.JTradit Chin Med 2002;22:26-28.
23.Kim TH,Basargard L,Kim JI,et al.Mongolian traditional style blood-letting therapy:a brief introduction.Complement Ther Clin Pract 2011;17:179-183.
24.Wu GW,Lin M,Chen ZB.Effect of auricular apex bloodletting therapy on 306 cases with hypertension.Shanghai JAcupunct Moxibust(Chin)1997;16:21.
25.Gu LNE.Effect of blood-letting therapy for hypertension.JMed Pharm Chin Minorit(Chin)2007;13:35.
26.Tian CA,Hao JF.The effect of blood-letting therapy on blood rheology of hypertension.J Clin Acupunct Moxibust(Chin)2002;18:27-28.
27.Wang CL.Clinical application of blood-letting therapy.JExtern Ther Tradit Chin Med(Chin)2004;13:18.
28.Rapoport RM.Nitric oxide inhibition of endothelin-1 release in the vasculature:in vivo relevance of in vitro findings.Hypertension 2014;64:908-914.
29.Chen HD,Wang CM,Fang Z.Effect of auricular apex blood-letting on serum NO in hypertensive rats with Liver yang hyperactivity syndrome.Arch Tradit Chin Med(Chin)2004;22:817-819.
30.Chen HD,Fang Z,Wang CM.Experimental study of auricular apex blood-letting in hypertensive rats with Liver yang hyperactivity syndrome.Chin J Integr Med Cardiocerebrovasc Dis(Chin)2003;1:521-523.
31.Liberati A,Altman DG,Tetzlaff J,et al.The PRISMAstatement for reporting systematic reviews and metaanalyses of studies that evaluate health care interventions:explanation and elaboration.BMJ 2009;339:b2700.
32.Wang J,Feng B,Yang X,et al.Tianma Gouteng Yin as adjunctive treatment for essential hypertension:a systematic review of randomized controlled trials.EvidBased Complement Alternat Med 2013;2013:e706125.
33.Higgins JPT,Sally G.Cochrane handbook for systematic reviews of interventions version 5.3.0(updated 2014).The Cochrane Collaboration;2014.Available from:www.cochrane-handbook.org.
34.Wang FY,Teng XY.Clinical observation on the effect of blood-letting therapy for hypertension with stageⅠandⅡ.Acta Chin Med Pharm(Chin)1999;27:46.
35.Hu WY,Gong YY,Zou X,et al.Effect of blood-letting therapy on Xingjian(LR 2)for the treatment of hypertension with Liver yang hyperactivity syndrome.Jiangxi J Tradit Chin Med(Chin)2012;43:53-54.
36.Deng SF.Blood-letting therapy for vertigo in hypertensive patients.Shanghai J Acupunct Moxibust(Chin)1989;8:22-23.
37.Chen HD,Wang CM.Therapeutic effect of blood-letting in ear apex on hypertension of hyperactivity of Liver-yang.Chin Acupunct Moxibust(Chin)2004;24:229-231.
38.Wang FX,Kang J.Effect of blood-letting in ear apex and auricular seed-pressing therapy combined with antihypertensive drugs for hypertension.Hebei Med(Chin)2014;20:1715-1718.
39.Wen ZJ,Zhou WH.Clinical observation on the effect of blood-letting therapy for hypertension.J Pract Tradit Chin Med(Chin)2014;30:520.
40.Zhang GQ.Blood-letting therapy for 60 patients with hypertension.Chin J Ethnomed Ethnopharm(Chin)2014;23:12.
41.Holsworth RE Jr,Cho YI,Weidman JJ,et al.Cardiovascular benefits of phlebotomy:relationship to changes in hemorheological variables.Perfusion2014;29:102-116.
42.Kuchel GA,Avorn J,Reed MJ,et al.Cardiovascular responses to phlebotomy and sitting in middle-aged and elderly subjects.Arch Intern Med 1992;152:366-370.
2.James PA,Oparil S,Carter BL,et al.2014 evidence-based guideline for the management of high blood pressure in adults report from the panel members appointed to the Eighth Joint National Committee(JNC8).J Am Med Assoc2014;311:507-520.
3.Mancia G,Fagard R,Narkiewicz K,et al.2013 ESH/ESCguidelines for the management of arterial hypertension:the task force for the management of arterial hypertension of the European Society of Hypertension(ESH)and the European Society of Cardiology(ESC).Eur Heart J2013;34:2159-2219.
4.Chow CK,Teo KK,Rangarajan S,et al.Prevalence,awareness,treatment,and control of hypertension in rural and urban communities in high-,middle-,and low-income countries.J Am Med Assoc 2013;310:959-968.
5.Guo F,He D,Zhang W,et al.Trends in prevalence,awareness,management,and control of hypertension among United States adults,1999 to 2010.J Am Coll Cardiol 2012;60:599-606.
6.Bauchner H,Fontanarosa PB,Golub RM.Updated guidelines for management of high blood pressure:recommendations,review,and responsibility.J Am Med Assoc 2014;311:477-478.
7.Xiong XJ.Integrating traditional Chinese medicine into Western cardiovascular medicine:an evidence-based approach.Nat Rev Cardiol 2015;12:e374.
8.Vora CK,Mansoor GA.Herbs and alternative therapies:relevance to hypertension and cardiovascular diseases.Curr Hypertens Rep 2005;7:275-280.
9.Xiong X,Borrelli F,de SáFerreira A,et al.Herbal medicines for cardiovascular diseases.Evid Based Complement Alternat Med 2014;2014:e809741.
10.Brook RD,Appel L J,Rubenfire M,et al.Beyond medications and diet:alternative approaches to lowering blood pressure.Hypertension 2013;61:1360-1383.
11.Xiong XJ,Yang XC,Liu YM,et al.Chinese herbal formulas for treating hypertension in traditional Chinese medicine:perspective of modern science.Hypertens Res2013;36:570-579.
12.Xiong XJ,Liu W,Yang XC,et al.Ginkgo biloba extract for essential hypertension:a systemic review.Phytomedicine2014;21:1131-1136.
13.Xiong XJ,Wang PQ,Li SJ,et al.Garlic for hypertension:a systematic review and meta-analysis of randomized controlled trials.Phytomedicine 2015;32:352-361.
14.Flachskampf FA,Gallasch J,Gefeller O,et al.Randomized trial of acupuncture to lower blood pressure.Circulation2007;115:3121-3129.
15.Xiong XJ,Liu W,Yang XC,et al.Moxibustion for essential hypertension.Complement Ther Med 2014;22:187-195.
16.Xiong XJ,Li SJ,Zhang YQ.Massage therapy for essential hypertension:a systematic review.J Hum Hypertens2015;29:143-151.
17.Goertz CH,Grimm RH,Svendsen K,et al.Treatment of hypertension with alternative therapies(THAT)study:a randomized clinical trial.J Hypertens 2002;20:2063-2068.
18.Xiong X,Wang P,Li X,et al.Qigong for hypertension:a systematic review.Medicine 2015;94:e352.
19.Posadzki P,Cramer H,Kuzdzal A,et al.Yoga for hypertension:a systematic review of randomized clinical trials.Complement Ther Med 2014;22:511-522.
20.Wang J,Feng B,Yang X,et al.Tai Chi for essential hypertension.Evid-Based Complement Alternat Med2013;2013:e215254.
21.Hur MH,Lee MS,Kim C,et al.Aromatherapy for treatment of hypertension:a systematic review.J Eval Clin Pract2012;18:37-41.
22.Yang HX.Clinical application of blood-letting therapy.JTradit Chin Med 2002;22:26-28.
23.Kim TH,Basargard L,Kim JI,et al.Mongolian traditional style blood-letting therapy:a brief introduction.Complement Ther Clin Pract 2011;17:179-183.
24.Wu GW,Lin M,Chen ZB.Effect of auricular apex bloodletting therapy on 306 cases with hypertension.Shanghai JAcupunct Moxibust(Chin)1997;16:21.
25.Gu LNE.Effect of blood-letting therapy for hypertension.JMed Pharm Chin Minorit(Chin)2007;13:35.
26.Tian CA,Hao JF.The effect of blood-letting therapy on blood rheology of hypertension.J Clin Acupunct Moxibust(Chin)2002;18:27-28.
27.Wang CL.Clinical application of blood-letting therapy.JExtern Ther Tradit Chin Med(Chin)2004;13:18.
28.Rapoport RM.Nitric oxide inhibition of endothelin-1 release in the vasculature:in vivo relevance of in vitro findings.Hypertension 2014;64:908-914.
29.Chen HD,Wang CM,Fang Z.Effect of auricular apex blood-letting on serum NO in hypertensive rats with Liver yang hyperactivity syndrome.Arch Tradit Chin Med(Chin)2004;22:817-819.
30.Chen HD,Fang Z,Wang CM.Experimental study of auricular apex blood-letting in hypertensive rats with Liver yang hyperactivity syndrome.Chin J Integr Med Cardiocerebrovasc Dis(Chin)2003;1:521-523.
31.Liberati A,Altman DG,Tetzlaff J,et al.The PRISMAstatement for reporting systematic reviews and metaanalyses of studies that evaluate health care interventions:explanation and elaboration.BMJ 2009;339:b2700.
32.Wang J,Feng B,Yang X,et al.Tianma Gouteng Yin as adjunctive treatment for essential hypertension:a systematic review of randomized controlled trials.EvidBased Complement Alternat Med 2013;2013:e706125.
33.Higgins JPT,Sally G.Cochrane handbook for systematic reviews of interventions version 5.3.0(updated 2014).The Cochrane Collaboration;2014.Available from:www.cochrane-handbook.org.
34.Wang FY,Teng XY.Clinical observation on the effect of blood-letting therapy for hypertension with stageⅠandⅡ.Acta Chin Med Pharm(Chin)1999;27:46.
35.Hu WY,Gong YY,Zou X,et al.Effect of blood-letting therapy on Xingjian(LR 2)for the treatment of hypertension with Liver yang hyperactivity syndrome.Jiangxi J Tradit Chin Med(Chin)2012;43:53-54.
36.Deng SF.Blood-letting therapy for vertigo in hypertensive patients.Shanghai J Acupunct Moxibust(Chin)1989;8:22-23.
37.Chen HD,Wang CM.Therapeutic effect of blood-letting in ear apex on hypertension of hyperactivity of Liver-yang.Chin Acupunct Moxibust(Chin)2004;24:229-231.
38.Wang FX,Kang J.Effect of blood-letting in ear apex and auricular seed-pressing therapy combined with antihypertensive drugs for hypertension.Hebei Med(Chin)2014;20:1715-1718.
39.Wen ZJ,Zhou WH.Clinical observation on the effect of blood-letting therapy for hypertension.J Pract Tradit Chin Med(Chin)2014;30:520.
40.Zhang GQ.Blood-letting therapy for 60 patients with hypertension.Chin J Ethnomed Ethnopharm(Chin)2014;23:12.
41.Holsworth RE Jr,Cho YI,Weidman JJ,et al.Cardiovascular benefits of phlebotomy:relationship to changes in hemorheological variables.Perfusion2014;29:102-116.
42.Kuchel GA,Avorn J,Reed MJ,et al.Cardiovascular responses to phlebotomy and sitting in middle-aged and elderly subjects.Arch Intern Med 1992;152:366-370.