A Meta-analysis Of The Effectiveness And Safety Of Traditional Chinese Medicine In Treating Hypertension With Renal Damage In The Early And Mid-term

Research purposesTo systematically evaluate the efficacy and safety of traditional Chinese medicine in the treatment of early and middle stage renal hypertension.Research method1.According to the Cochrane Collaboration System evaluation method,search 5 major databases,Chinese database:China National Knowledge Infrastructure(CNKI),Wanfang Data,Weipu,Medline via PubMed and Cochrane Library.The search date was from the establishment of the library to June 2018.2.Screening conditions:The diagnostic criteria were early and middle stage renal hypertension;the treatment group used oral Chinese medicine preparation plus western medicine antihypertensive drugs,the control group was treated with western medicine alone;the urine microalbumin(mALB)was the main outcome index,including blood pressure.(BP),serum creatinine(Cr),urea nitrogen(BUN),urine ?2 microglobulin(urine ?2-MG),blood ?2 microglobulin(blood ?2-MG),serum cystatin C(Cys C),Randomized controlled trials of secondary outcome measures such as urinary NAG enzyme(NAG),blood lipids,and TCM syndrome scores.3.The literature will be included in the literature to extract general information,methodological related information,research objects,interventions and other relevant information,and extract the outcome indicator data.4.The results of the outcome data were analyzed and summarized using Revman 5.3 software.The analysis index was a continuous variable,and the mean difference MD was used to describe the 95%confidence interval CI(confidence interval).Meta-analysis is performed on data with lower heterogeneity,and data with higher heterogeneity is specified.5.Conduct a safety analysis of the adverse reactions described in the study.6.Conduct a publication bias assessment based on the inverted funnel plot.Research resultA total of 27 randomized controlled trials involving a total of 2,070 patients with early-stage renal impairment of hypertension were included.Can be divided into 5 categories:1 Chinese medicine+ARB vs ARB group,including 8 studies;2 Chinese medicine+ACEI vs ACEI group,including 8 studies;3 Chinese medicine+ARB+CCB vs ARB+CCB group,including 3 studies;4 Chinese medicine+CCB vs CCB group,including 3 studies;5 Chinese medicine + Western medicine antihypertensive drug group vs western medicine antihypertensive drug group,including 5 studies.In the reduction of urinary albumin,27 studies reported this indicator,and 8 studies showed that Chinese medicine+ARB was better than ARB alone.Three courses of 4 weeks of study suggested that Chinese medicine+ACEI was superior to the simple ACEI group;two courses of 8 weeks showed no significant difference between Chinese medicine+ACEI and simple ACEI group;2 courses of 12 weeks showed that Chinese medicine+The efficacy of ACEI was better than that of the ACEI group alone.One course of treatment for 16 weeks showed that the efficacy of Chinese medicine+ACEI was better than that of the simple ACEI group.Three studies showed that Chinese medicine+ARB+CCB was better than ARB+CCB alone.In the three studies of Chinese medicine+CCB vs CCB group,after removing the possible heterogeneity sources,the remaining two trials showed that the Chinese medicine+CCB group was better than the CCB group alone.Four studies of Chinese medicine+western medicine antihypertensive drugs group vs western medicine antihypertensive drugs group showed that the efficacy of traditional Chinese medicine+western medicine antihypertensive drugs was better than that of western medicine antihypertensive drugs.In terms of reducing systolic blood pressure,15 studies reported this index,divided into 4 groups according to the intervention,1 Chinese medicine+ARB 2 Chinese medicine+ACEI 3 Chinese medicine+CCB 4 Chinese medicine+ARB+CCB.The results showed that there was no difference between the traditional Chinese medicine+western medicine group and the western medicine group in the ARB group;the difference in the CCB group was not statistically significant;the other two groups were better than the western medicine group in reducing the systolic blood pressure.In terms of reducing diastolic blood pressure,15 studies reported this index,divided into 4 groups according to the intervention,1 Chinese medicine+ARB 2 Chinese medicine+ACEI 3 Chinese medicine+CCB 4 Chinese medicine+ARB+CCB.The results showed that the combination of ACEI and Western medicine showed no difference between the Chinese medicine and Western medicine.There was no significant difference in the CCB group.The other two groups were better than the Western medicine group in reducing the diastolic blood pressure.In terms of lowering serum creatinine,there are 7 studies reporting this indicator,divided into 2 groups according to the intervention,1 Chinese medicine+ARB 2 Chinese medicine+ACEI.The results showed that the two groups of integrated traditional Chinese and Western medicine treatment improved serum creatinine efficacy than the western medicine group.In terms of reducing urea nitrogen,there are 6 studies reporting this indicator,divided into 2 groups according to the intervention,1 Chinese medicine+ARB 2 Chinese medicine+ACEI.The results showed that there was no difference between the traditional Chinese medicine+western medicine group and the western medicine group in the ARB group.The efficacy of the combination of traditional Chinese medicine and western medicine in the ACEI group was better than that of the western medicine group.In the reduction of urinary ?2 microglobulin,there are 14 studies reporting this indicator,according to the intervention measures are divided into 4 groups,1 Chinese medicine+ARB 2 Chinese medicine+ACEI 3 Chinese medicine+CCB 4 Chinese medicine+Western medicine antihypertensive drugs.The results showed that there was no difference between the traditional Chinese medicine+western medicine group and the western medicine group in the western medicine antihypertensive drug group;the other three groups were better than the western medicine group in improving the therapeutic effect of urinary ?2 microglobulin.In the reduction of blood ?2 microglobulin,there are 9 studies reporting this indicator,divided into 2 groups according to the intervention,1 Chinese medicine +ARB 2 Chinese medicine+ACEI 3 Chinese medicine+CCB.The results showed that there was no significant difference between the Chinese medicine+CCB group;the other two groups of integrated Chinese and Western medicine treatment improved blood ?2 microglobulin efficacy is better than the western medicine group.In the reduction of serum cystatin C,there are 7 studies reporting this indicator,according to the intervention measures are divided into 5 groups,1 Chinese medicine+ARB 2 Chinese medicine+ACEI 3 Chinese medicine+CCB 4 Chinese medicine+ARB+CCB 5 Chinese medicine+Western medicine blood pressure medicine.The results showed that there was no significant difference between the ACEI group and the CCB group.The other three groups were better than the western medicine group in improving the serum cystatin C treatment.In the reduction of urinary NAG enzymes,there are 3 studies reporting this indicator,according to the intervention measures are divided into 3 groups,1 Chinese medicine+ARB2 Chinese medicine+CCB 4 Chinese medicine+Western medicine antihypertensive drugs.The results showed that the combination of traditional Chinese and Western medicine in the treatment of urinary NAG enzyme was better than the western medicine group.In terms of improving blood lipids,four trials described cholesterol markers,four trials described triglycerides,and three trials described low-density lipoproteins,all of which belonged to the ACEI group.The results showed that there was no difference between cholesterol,low-density lipoprotein-Chinese medicine and western medicine in the western medicine group.The efficacy of the triglyceride-integrated Chinese and Western medicine treatment group was better than that of the western medicine group alone.In terms of TCM symptom scores,there are 7 studies reporting this indicator,according to the intervention measures are divided into 4 groups,1 Chinese medicine+ARB 2 Chinese medicine + ACEI 3 Chinese medicine + CCB 4 Chinese medicine + Western medicine antihypertensive drugs.The results showed that the combination of TCM and Western medicine in the treatment of TCM symptom scores was better than the Western medicine group.In the statistics of TCM symptom efficiency,13 trials recorded this index.According to the efficacy evaluation criteria,13 trials were divided into effective group 1 and effective group 2.and the results showed the TCM symptom of the combination of TCM and Western medicine.The effectiveness is higher than that of simple western medicine.Of the 27 papers in terms of safety,13 did not mention adverse reactions,6 reported that there were no adverse reactions in the experimental group and the control group,and 12 reports reported adverse reactions such as dizziness,dry cough,nausea,vomiting,and bloating.One patient in the control group withdrew from the test system due to intolerance.After analysis,there was a statistically significant difference in the symptoms of dry cough between the two groups.The difference in adverse reactions was not statistically significant.It is believed that Chinese medicine has no serious adverse reactions in the treatment of early and middle stage renal hypertension.Analysis conclusion1.Traditional Chinese medicine treatment of patients with early-stage renal damage with high blood pressure is better than western medicine in reducing urinary albumin.However,there is no difference between the two groups in the comparison of traditional Chinese medicine+ARB+CCB and simple ARB+CCB.2.Chinese medicine treatment of early and middle-stage renal damage in high blood pressure,blood creatinine,urea nitrogen,blood,urine ?2 microglobulin,serum cystatin C and urinary NAG enzyme,the overall efficacy is better than Western medicine treatment,but In the comparison with ARB alone,there was no difference in the efficacy of reducing systolic blood pressure and improving urea nitrogen in the two groups;compared with ACEI,there was no difference in the efficacy of reducing diastolic blood pressure.3.Among the blood lipid indicators,the efficacy of traditional Chinese medicine for improving triglycerides is better than that of western medicine.The effect of improving cholesterol and low-density lipoprotein cholesterol is no different from that of western medicine.4.Chinese medicine can reduce TCM symptom scores in patients with early and middle-stage renal damage and improve efficiency.5.Traditional Chinese medicine treatment of high blood pressure in the early and middle stages of hypertension does not increase the adverse reactions of patients.