Evidence System Establishment Of Acupuncture Therapy For Treating Essential Hypertension:based On The Network Meta-analysis Approach

ObjectiveLTo systematically evaluate the clinical evidence of the acupuncture therapy for hypertension.Based on network meta-analysis and The Grading of Recommendations Assessment,Development and Evaluation(GRADE),to form the evidence of efficacy and safety.According to the clinical interviews,to evaluate the health economic parameters and the patients' preferences.Based on these above,to establish the evidence system of the acupuncture for hypertension and provide evidence basis for clinical practice.Method:1.Systematically collect the evidence of acupuncture treatment for hypertension,evaluate the methodological and evidence quality of existing evidence through the Assessing the Methodological Quality of Systematic Review tool,to obtain the information of evidence status.2.Systematically collect the current randomized controlled studies of acupuncture therapy in the treatment of hypertension.Using the methods of network meta-analysis and GRADE system,taking clinical treatment time and drug control as subgroups,blood pressure changes before and after treatment as main outcome indicators,summarize and analyze the effects of different acupuncture methods on blood pressure,then form the latest evidence of acupuncture for hypertension.3.Through investigation of hypertensive patients,the economic parameters of acupuncture and moxibustion and drug treatment for hypertension is investigated and calculated,and the direct and indirect costs of different interventions are calculated based on the interview results;the treatment period is 4 weeks;the blood pressure change value is obtained by systematic evaluation;the analysis is carried out through the method of minimum cost analysis of health economics and incremental cost-effectiveness analysis.To study the economic parameters of acupuncture and moxibustion therapy relative to drug treatment,and to establish the economic evidence of acupuncture and moxibustion therapy for hypertension.4.Based on the clinical survey and the evaluation method of visual analogue scale,the treatment preference of patients with hypertension is studied,and the influencing factors are analyzed by binary logistic regression to clarify the preference of patients with hypertensionResults:1.A total of 19 pieces of evidence for the treatment of essential hypertension by acupuncture and moxibustion are obtained through systematic evaluation and meta-analysis.According to the quantitative score of AMSTAR 2,the integrated method quality scores of the 19 studies are all low,with an average total score of 14.68.The quality of the included systematic evaluation methodology is lower in items 2,3,7,10,12,14,15,16.2.A total of 64 randomized controlled trials of acupuncture treatment for essential hypertension are included through retrieval.Most of the included studies fail to conduct the allocation concealment and the blinding evaluation.The methodological bias is large.According to the clinical treatment time and different drugs are divided into four time subgroups to compare the antihypertensive effect of different acupuncture therapy and different drug therapy.The combined results show that:after 4 weeks or more of treatment,there is no statistical difference in blood pressure reduction between different acupuncture methods and drug therapy,and the combination of acupuncture and drug therapy is superior to drug therapy alone in lowering blood pressure,SBP are more significant.However,due to the low overall methodological quality of the included studies,the small number of direct comparison of studies on moxibustion,warm needle and electroacupuncture,the poor accuracy of combined effect amount,the risk of publication bias and small sample effect,and other factors affecting the quality of the evidence body,the overall evidence quality of the evidence body is low3.After preliminary sample size calculation,a total of 81 patients are included for clinical interviews.After interview and calculation,the total cost of drug intervention for hypertension is 425.28 yuan after 4 weeks of treatment.The total cost of acupuncture treatment is 2,566.08 yuan.The total cost of acupuncture combined with medicine is 2,653.68 yuan.Based on the effect value and minimum cost analysis of meta-analysis,there is no statistically significant difference between acupuncture therapy and drug therapy,but there is no economic advantage.Based on ICER analysis,acupuncture combined with drug therapy is more effective than drug therapy alone in lowering blood pressure value,it increases the effect value by one unit,and costs SBP and DBP 135.71 yuan and 495.2 yuan respectively,which exceeds the maximum willingness to pay of patients obtained through investigation.So combined therapy does not have economic advantages.4.Through the clincal interviews with 81 patients,the median number of patients'preference is 3(mean value is 3.29),indicating that patients prefer to choose drug therapy in the treatment of hypertension.Logistic regression analysis showed that the three factors have statistical significance in patients'preference selection:hypertension course(P=0.048),whether the patient have acupuncture treatment experience(P=0.000),and whether the current blood pressure reache the standard(P=0.027);that is,patients with short illness time,acupuncture treatment experience and current blood pressure not reaching the standard are more inclined to choose acupuncture therapy.Conclusion1.The clinical evidence system of acupuncture and moxibustion for the treatment of essential hypertension has been basically constituted,that is,the current low quality evidence shows that:in the short-term treatment of essential hypertension,acupuncture and moxibustion combined with drug therapy is more effective than drug therapy alone,and acupuncture combined with drug therapy to reduce SBP of patients is more significant.However,acupuncture and moxibustion has no obvious economic advantage over drugs,and patients have no obvious preference for acupuncture and moxibustion treatment.2.Based on the existing evidence system,it is shown that acupuncture therapy can be used as an alternative complementary and alternative therapy in the treatment of clinical essential hypertension.Combined with drug therapy,better hypotensive effect can be achieved.3.Clinical research of acupuncture treatment of hypertension,should increase the methodology guidance,enhance the scientific nature of the study design,in response to acupuncture clinical characteristics of the forward curative effect evaluation,comprehensive health economics evaluation of acupuncture and moxibustion,give attention to two or more things to expand the evidence base,improve the quality of the evidence system,to better guide the clinical practice of acupuncture and moxibustion.