Effect of melatonin on nocturnal blood pressure: meta-analysis of randomized controlled trials
Effect of melatonin on nocturnal blood pressure: meta-analysis of randomized controlled trials
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DOI：
10.2147/vhrm.s24603
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发表时间：
2011-01-01
影响因子：
2.9
通讯作者：
Zisapel, Nava
中科院分区：
文献类型：
--
作者：
Grossman, Ehud;Laudon, Moshe;Zisapel, Nava
背景资料：夜间高血压患者发生心血管并发症的风险较高，如心肌梗死和脑血管损伤。已发表的研究不一致地报道了褪黑素降低夜间血压的作用。方法：采用符合纳入标准的所有研究的随机效应模型，对外源性褪黑素改善夜间血压的有效性和安全性进行荟萃分析，并对速释制剂和控释制剂进行亚组分析。七个试验（三个控制释放和四个快速释放褪黑激素）与221名参与者。所有7项研究的荟萃分析均未显示褪黑激素与安慰剂相比对夜间血压有显著影响。然而，亚组分析显示，控释褪黑激素显着降低夜间血压，而快速释放褪黑激素没有效果。控释褪黑激素组的收缩压显著降低（-6.1 mmHg; 95%可信区间[CI] -10.7 ~-1.5; P = 0.009），而速释褪黑激素组的收缩压无显著降低（-0.3 mmHg; 95% CI -5.9 ~5.30; P = 0.92）。控释褪黑激素组舒张压也显著降低（-3.5 mmHg; 95% CI -6.1至-0.9; P = 0.009），但速释褪黑激素组无此作用（-0.2 mmHg; 95% CI -3.8至3.3; P = 0.89）。结论：在降压治疗中添加控释褪黑素对改善夜间高血压有效且安全，而速释褪黑素无效。为了确定控释褪黑激素对夜间高血压患者的长期有益作用，有必要进行更长时间的大型试验。
Background: Patients with nocturnal hypertension are at higher risk for cardiovascular complications such as myocardial infarction and cerebrovascular insult. Published studies inconsistently reported decreases in nocturnal blood pressure with melatonin.Methods: A meta-analysis of the efficacy and safety of exogenous melatonin in ameliorating nocturnal blood pressure was performed using a random effects model of all studies fitting the inclusion criteria, with subgroup analysis of fast-release versus controlled-release preparations.Results: Seven trials (three of controlled-release and four of fast-release melatonin) with 221 participants were included. Meta-analysis of all seven studies did not reveal significant effects of melatonin versus placebo on nocturnal blood pressure. However, subgroup analysis revealed that controlled-release melatonin significantly reduced nocturnal blood pressure whereas fastrelease melatonin had no effect. Systolic blood pressure decreased significantly with controlledrelease melatonin (-6.1 mmHg; 95% confidence interval [CI] -10.7 to -1.5; P = 0.009) but not fast-release melatonin (-0.3 mmHg; 95% CI -5.9 to 5.30; P = 0.92). Diastolic blood pressure also decreased significantly with controlled-release melatonin (-3.5 mmHg; 95% CI -6.1 to -0.9; P = 0.009) but not fast-release melatonin (-0.2 mmHg; 95% CI -3.8 to 3.3; P = 0.89). No safety concerns were raised.Conclusion: Add-on controlled-release melatonin to antihypertensive therapy is effective and safe in ameliorating nocturnal hypertension, whereas fast-release melatonin is ineffective. It is necessary that larger trials of longer duration be conducted in order to determine the long-term beneficial effects of controlled-release melatonin in patients with nocturnal hypertension.