Meta-analysis Of Folic Acid Combined With Antihypertensive Drugs In Patients With H-type Hypertension

Objective:Systematic evaluation was used to explore the efficacy of folic acid combined with antihypertensive drugs in patients with H-type hypertension,so as to provide evidence-based medical evidence for better treatment of H-type hypertension and improvement of patients’ prognosis.Methods:Randomized controlled trials（RCTs）of folic acid combined with conventional antihypertensive drugs（experimental group）and conventional antihypertensive drugs（control group）in patients with H-type hypertension of CNKI,CBM Wanfang Database,Embase,Pub Med,The Cochrane Library and Web of Science databases was established until 2022-5-1.Literature selection and data extraction were conducted according to inclusion and exclusion criteria,and the quality of the included literatures were evaluated by the bias risk assessment tool of the Cochrane system.Meta-analysis was performed using Rev Man5.3 and Stata15.1 software.Results:A total of 12385 patients of 25 RCTs were met the inclusion criteria.They were divided into experimental group（6277 cases）and control group（6108 cases）.Metaanalysis results showed that folic acid combined with antihypertensive drugs significantly reduced systolic blood pressure（SBP）in H-type hypertension patients compared with antihypertensive drugs alone（MD=-4.23,95% CI:-5.91～-2.54,P<0.001）,diastolic blood pressure（DBP）（MD=-1.78,95% CI:-2.93～-0.64,P=0.002）,plasma homocysteine（Hcy）（MD=-6.64,95% CI:-7.56～-5.72,P<0.001）,hs-CRP（MD=-1.39,95% CI:-1.90 ～-0.88,P< 0.001）,incidence of major cardiovascular diseases [including stroke（RR:0.56,95% CI: 0.46～0.68,P<0.001）,myocardial infarction（RR=0.51,95%CI: 0.28 ～ 0.94,P=0.030）,mortality from cardiovascular disease（RR=0.35,95%CI: 0.24 ～ 0.51,P < 0.001）,incidence of total cardiovascular and cerebrovascular events（RR=0.28,95%CI: 0.11～ 0.76,P=0.010）.Patients in the treatment group were also better at improving cardiac function after treatment[including left ventricular ejection fraction（LVEF）（MD=2.93,95% CI: 2.11～3.76,P<0.001）and early and late mitral diastolic peak flow（E/A）（MD=0.11,95%CI:0.06～0.16,P<0.001）];There was no statistical difference in the incidence of adverse reactions between the two groups（RR=0.95,95% CI: 0.52～ 1.75,P= 0.860）.Conclusion:Folic acid combined with conventional antihypertensive drugs significantly reduced blood pressure,Hcy,stroke,myocardial infarction,mortality from cardiovascular disease,incidence of total cardiovascular disease,and HS-CRP,and improved cardiac function（LVEF and E/A）without increasing significant adverse reactions.There was no significant difference in the efficacy of folic acid supplementation at different doses and times.Affected by the quality and quantity of the included studies,the above conclusion needs to be confirmed by more high-quality studies.