| Essential hypertension has the characteristics of elevated systemic arterial blood pressure.Long-term develoPment can be accompanied by heart,brain,kidney and other target organ damage and other complications.It is an important risk factor for cardiovascular and cerebrovascular health,and can increase cardiovascular events.With the change of life style,the prevalence of hypertension in China is still a rising state,the latest national hypertension report pointed out that in China adult hypertension prevalence rate of 20%;the global burden of disease study in 2010 found that the number of deaths caused by hypertension accounted for 1/4 of the proportion of deaths.Therefore,we think that hypertension seriously endangers the health of people and reduces the quality of life of the patients.Through the large electronic medical data show:in the TCM Syndromes of hypertension of liver yang hyperactivity and hyperactivity syndrome have accounted for a large proportion in the scientific and reasonable for this population,the intervention of traditional Chinese medicine,to improve life quality and prognosis of patients with hypertension is of great significance.Therefore,this study based on the principle of evidence-based medicine,the evaluation system and placebo randomized double-blind controlled clinical trial,the first randomized controlled trials on treatment liver hyperactivity hypertension meta analysis,and to evaluate the efficacy and safety of treatment of liver hypertension,on the basis of observation the safety and efficacy of songlingxuemaikang capsule intervention is low risk level 1 hypertensive patients with anxiety state,in the hope of Chinese medicine for the treatment of hypertension and provide evidence to support modern.This study is divided into four parts:literature review,the summary of experience of Da-zhuo Shi,systematic review and clinical observation.1 Literature review:firstly from theory and modern research of ancient physicians described the TCM disease name,etiology and pathogenesis of hypertension,and then focuses on the modern Chinese dimension and discusses the research situation of hypertension syndrome type distribution and treatment;summarizes the liver treatment effectiveness and safety of high blood pressure.2 The summary of experience of Da-zhuo Shi:Professor Shi is an expert in cardiovascular disease with combination of TCM and Western medicine chief physician,professor,chief researcher,under the tutelage of academician Chen Keji,for the unique experience on treating hypertension,significant clinical effect.This part focuses on summarizing the cognition and etiology of pathogenesis and pathogenesis of hypertension,emphasizing the etiology and pathogenesis of syndrome differentiation system based on liver and kidney.3 Systematic evaluation:screening the literature of randomized controlled trials in the database and systematically evaluating the effect of traditional Chinese medicine on hypertension.Objective:to systematically evaluate the safety and effectiveness of the treatment of hypertension by ping liver method,and to provide evidence support for the application of the traditional Chinese medicine in the treatment of hypertension.Methods:Retrieval strategy:a combination of electronic retrieval and manual retrieval was used to systematically retrieve Chinese and English databases,conference papers on cardiovascular diseases in China,and references in related articles.The objective:screening by two researchers according to the inclusion and exclusion criteria independently,opinions are not unified to third party consultation;if the document conforms to the selected standard,the relation data is extracted,and the methodological and reporting quality evaluation,Meta analysis was carried out using Revman5.3 software.Results:A total of 14 literatures were included in this study,including 14 randomized controlled trials.The methodological quality and the quality of the reports obtained were low.Meta analysis showed that:(1)single Chinese medicine and conventional antihypertensive medicine liver contrast:?In the blood pressure value,single flat conventional treatment of liver of traditional Chinese medicine with western medicine,can significantly reduce the systolic blood pressure of[MD=-10.07,95%CI(-16.83,-3.32)and diastolic blood pressure[MD=-7.97,95%CI(-10.61,-5.32)].? Ping Gan Chinese medicine can improve the efficacy of TCM syndrome comPared with conventional western medicine.?In lowering blood lipid level,Ping Gan Chinese medicine can reduce the total cholesterol,triglyceride and LDL significantly.(2)Liver Chinese medicine combined with conventional western medicine with conventional western medicine comparison:? In the blood pressure value,liver of traditional Chinese medicine combined with conventional western medicine treatment compared with conventional western medicine,can significantly reduce systolic blood Pressure[MD=-7.37,95%CI(-8.83,-5.91)]and diastolic blood pressure[MD=-4.57,95%CI(-5.42,-3.71)].? In the effect of reducing blood pressure,the curative effect of the traditional Chinese medicine and the conventional western medicine was more obvious than that of the conventional western medicine,and the effect was more obvious[RR=1.25,95%CI(1.17,1.33)].? In terms of TCM syndrome score,Ping Gan Chinese medicine combined with routine western medicine treatment can significantly reduce TCM syndrome score[MD=-7.19,95%CI(-9.35,-5.03)]comPared with conventional western medicine.? In the treatment of TCM syndromes,Ping Gan Chinese medicine combined with conventional western medicine can improve the efficacy of TCM syndrome[MD=1.26,95%CI(1.17,1.3 6)]compared with conventional western medicine.No adverse reaction was found in all studies.Conclusion:Traditional Chinese medicine liver compared with conventional medicine in reducing blood pressure,improve the value of TCM syndromes,lower blood lipid levels showed certain advantages;liver Chinese medicine combined with western medicine in reducing blood pressure,improve the curative effect and improve the numerical antihypertensive TCM syndrome is superior to conventional Western medicine.But due to the low quality of trials,the research design is not rigorous,measure inconsistent effect,uneven distribution,for varying lengths of time and lack of long-term follow-up and potential publication bias and selection,detection and reporting of adverse reactions are not standardized and other reasons,therefore,effectiveness and safety about the use of liver treatment hyperactivity hypertension still needs more high-quality studies to support.4 Clinical observation:a single-center,double-blind,randomized controlled trial was used to demonstrate the effect of Ping liver medicine Pine age Xue Mai Kang on hypertension combined with anxiety.Objective:To observe the safety and effectiveness of Songling Xuemai Kang in the treatment of low medium-risk 1-grade hypertension with mild to moderate anxiety.Methods:single center,double-blind,randomized controlled study design,from December 2015 to December 2017 in Beijing Hepingli hospital is low risk level 1 hypertensive patients with mild to moderate anxiety(SAS 50-69)in patients with syndrome of hyperactivity of liver yang.The method was randomized into a randomized controlled group.The drug was blinded by the Chengdu Hong Hong pharmaceutical Co.Ltd.,and the simulated agent(the drug composition containing 5%drugs)with the same appearance as the Songling Xuemai Kang capsule was packaged seParately.The treatment group was given songlingxuemaikang capsules,1.5g/times,3 times a day,after 12 weeks,the control group was given the same dose of placebo,were evaluated before and after treatment of blood pressure,compliance rate,antihypertensive efficacy,TCM syndrome score and anxiety scale score,the European health scale in the health system and visual descriPtion of five simulation scale,Physicochemical index and angiotensin ?,homocysteine,C-reactive protein level.Results:70 patients were enrolled,adopt the method of random number table of the two groups of patients were randomly divided into treatment group(35 cases)and control group(35 cases),the treatment group of 3 patients failed to adhere to medication,interruption of treatment,the control group lost 4 patients did not complete the last index monitoring.Finally,63 patients were enrolled in the group,including 32 in the treatment group and 31 in the control group.There was no statistical difference between the two groups in age,sex,past medical history and basic drug use(P>0.05).(1)In the aspect of numerical pressure:before the treatment,the treatment group of patients with systolic blood pressure was 143.23 ± 16.17mmHg,diastolic blood pressure was 87.41±12.16 mmHg,control group patients with systolic blood pressure was 140.45 ± 19.40 mmHg,diastolic blood pressure was 88.30±11.20 mmHg,two groups of patients with systolic blood pressure and diastolic blood pressure in comparison had no significant difference(P>0.05).After treatment,the treatment group of patients with systolic blood pressure,diastolic blood pressure was 124.30±17.25mmHg,75.83±10.14mmHg,the control group of patients with systolic blood pressure,diastolic blood pressure was 132.30±19.55mmHg,84.34±9.15mmHg,systolic blood pressure and diastolic blood pressure levels compared with before treatment,with statistical difference(P<0.05)between the two groups had statistical differences(P<0.05).(2)In the aspect of antihypertensive effect:after treatment,the total number of 32 cases in the treatment group,24 cases reached the standard,the total number of 31 cases in the control group,17 cases reached the standard,there was a significant difference between the two groups in reaching the standard rate(P<0.05).(3)The scores of anxiety in table SAS:before treatment,the patients in the treatment group the SAS score was 58.74±6.19,the SAS score of the control group is 59.64±9.57,two groups had no significant difference(P>0.05);after 12 weeks of treatment,the treatment group SAS score was 45.78±9.26,the SAS score of the control group is 50.33 + 8.39 and there was statistical difference between two groups(P<0.001).(4)Before and after treatment of TCM Syndrome Distribution:two groups of patients before treatment,no significant difference in the main symPtom(P>0.05),compared two groups of patients after treatment,there were significant differences in the aspects of vertigo,headache,tinnitus,facial Hongre(P<0.05).(5)Before and after treatment of TCM syndrome score:before treatment,the patients in the treatment group of TCM syndrome score was 18.22 ± 3.19,patients in the control group of TCM syndrome score was 9.78±4.26,two groups had no significant difference(P>0.05);after 12 weeks of treatment,the treatment group of TCM syndrome score was 19.64±4.57,the control group patients TCM syndrome score was 15.23±8.39,there was statistical difference between two groups(P>0.05).(6)In terms of quality of life:before treatment,the patients in the treatment group the EQ-5D score was 0.693±0.14,the control group score was 0.712±0.18,two groups had no significant difference;after treatment,the treatment group EQ-5D score was 0.891±0.09,0.803±0.20in the control group,there was statistical difference between two groups(P<0.05);treatment the EQ-VAS score of the treatment group is 70.85 ±9.23,the control group is 72.44 ± 10.77;after treatment,the treatment group is 89.57±8.13,80.75±11.20in the control group,there was statistical difference between two groups(P<0.05).(7)The Physical and chemical indicators before treatment,the patients in the treatment group,the level of angiotensin II was 145.4 ± 12.1 pg/ml,the control group was 151.4 ±13.5 pg/ml,the two groups had no statistical difference(P>0.05);after treatment,the treatment group of angiotensin ? level was 121.8 ± 13.1 pg/ml,the control group is 147.7±12.2 pg/ml,there was statistical difference between two groups(P<0.05).Before treatment,the treatment group of patients with C reactive protein level was 9.26±2.56 mg/L,the control group was 8.71±2.95mg/L,two groups had no significant difference(P>0.05);after treatment,the treatment group of C reactive protein level was 8.18±2.42mg/L,the control group was 8.32±3.55 mg/L,no statistical difference between the two groups(P>0.05).Before treatment,the patients in the treatment group homocysteine level was 12.2±4.1umol/l,the control group was 13.4 ± 3.6 umol/l,the two groups had no statistical difference(P>0.05);after treatment,the treatment group of homocysteine was 12.1 ±3.1 umol/l,the control group was 12.7 ± 2.2 umol/l,two group showed no significant difference(P>0.05).Study on the correlation between the severity of hypertension of liver yang hyperactivity and inflammatory factors,vascular endothelial injury,RAS system activation degree and anxiety:according to the survey collected before treatment was combined with the latest hypertension of liver yang hyperactivity syndrome scoring system,on the basis of hypertension of liver yang hyperactivity syndrome score,patients were divided into mild and severe the two group.A total of 70 PeoPle were collected before the treatment,of which 39 were mild hypertension with hyperactivity of liver Yang,31 patients with severe hypertension and hyperactivity of liver yang hyperactivity.The study found that severe and mild hyperactivity of liver yang hyperactivity of liver Yang in patients with C reactive protein levels were 12.21 ± 1.96 mg/1,respectively 9.16±2.01 mg/1,the difference was statistically significant(P<0.05);Severe and mild hyperactivity of liver yang hyperactivity of liver Yang homocysteine in patients with 13.42 1±4.41 umol/1,respectively 11.26± 3.06umol/l,the difference was statistically significant(P<0.05);Severe hyperactivity of liver Yang Syndrome and mild liver yang hyperactivity syndrome in patients with vascular angiotensin ? levels were 143.73±14.67 pg/ml,respectively 129.35±12.11 pg/ml,there was no statistically significant difference(P>0.05);Severe and mild hyperactivity of liver yang hyperactivity of liver Yang the anxiety of the patients SAS scores were 68.64±8.16,respectively 49.86 ± 7.01,the difference was statistically significant(P<0.05).Safety observation:the liver function(ALT,AST),renal function(Cr,BUN)of the patients before and after treatment were not obviously abnormal in four blood clotting items.1 patients in the treatment group had diarrhea after taking medicine,and the symptoms disaPPeared after taking the medicine.Conclusion:Songlingxuemaikang caPsule can further reduce the hyperactivity of liver Yang tyPe low risk grade 1 hyPertensive patients with mild to moderate anxiety,improve the antihyPertensive effect,improve the TCM syndrome and TCM syndrome score decreased,and can improve the anxiety symptoms and improve the patients' quality of life,but also can reduce the level of angiotensin ?.Study on the correlation between the severity of hypertension of liver yang hyperactivity and inflammatory factors,vascular endothelial injury,RAS system activation degree and anxiety:hyperactivity of liver Yang Syndrome and inflammatory factors and endothelial function are closely related,the study also found that liver yang hyperactivity and anxiety scores are related. |
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