Clinical Effectiveness of Non-Drug Treatment for Hypertension: a Meta-Analysis
Clinical Effectiveness of Non-Drug Treatment for Hypertension: a Meta-Analysis
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高血压非药物治疗的临床疗效：荟萃分析
DOI：
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发表时间：
1994
影响因子：
3.8
通讯作者：
L. Chambers
中科院分区：
文献类型：
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作者：
W. Linden;L. Chambers
我们使用 166 项研究对原发性高血压治疗的临床效果进行了荟萃分析，这些研究评估了利尿剂、β 受体阻滞剂和钙通道阻滞剂、减肥、钠和酒精限制、体育锻炼、钙和钾补充剂、单成分和多成分放松疗法以及个体化认知行为疗法的效果。研究结果与之前的评论一致，即减轻体重、体育锻炼、减少钠和酒精摄入量、钾补充剂和标准化放松治疗可导致压力降低，而压力降低大多低于药物治疗观察到的效应大小。在非药物方法中，减肥/体育锻炼和个体化认知行为心理治疗特别有效，并且在观察到的收缩压降低的原始效应大小方面与药物治疗没有差异。钙补充剂是最无效的干预措施。药物治疗的初始血压水平高于非药物治疗，药物/非药物治疗的平均收缩压分别为 154.1 mmHg 和 145.4 mmHg，舒张压分别为 101.5 mmHg 和 94.3 mmHg。在调整初始压力水平的差异后，非药物治疗的效果增加，个体化心理治疗的效果大小与药物治疗降低收缩压和舒张压的效果大小相匹配。这些发现表明，一些非药物疗法比通常认为的更有效，尤其是考虑到治疗前血压水平的差异时。
We conducted a meta-analysis of the clinical effectiveness of treatments for essential hypertension using 166 studies that evaluated the effects of diuretics, beta-blockers, and calcium-channel blockers, weight reduction, sodium and alcohol restriction, physical exercise, calcium and potassium supplements, single-component and multi-component relaxation therapy, and individualized cognitive-behavioral therapies. The findings were consistent with previous reviews that weight reduction, physical exercise, reduced sodium and alcohol intake, potassium supplements, and standardized relaxation treatments led to pressure reductions which mostly fell below effect size magnitudes observed with drug therapies. Of the non-drug approaches, weight reduction/physical exercise, and individualized cognitive-behavioral psychological therapy were particularly effective and did not differ from drug treatments in observed raw effect sizes for systolic blood pressure reductions. Calcium supplements were the least effective intervention. Drug therapies were initiated at higher initial levels of blood pressure than non-drug therapies with average pressures of 154.1 mmHg vs. 145.4 mmHg systolic and 101.5 mmHg vs. 94.3 mmHg diastolic pressure for drug/non-drug treatments respectively. After adjustment for differences in initial pressure levels, the effects for non-drug therapies increased, and the effect size of individualized psychological therapy matched the effect sizes of drug treatments for systolic and diastolic pressure reduction. These findings suggest that some non-drug therapies are more effective than commonly believed especially when differences in pre-treatment blood pressure levels are accounted for.