Lowering blood pressure: a systematic review of sustained effects of non-pharmacological interventions
Lowering blood pressure: a systematic review of sustained effects of non-pharmacological interventions
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DOI：
10.1093/oxfordjournals.pubmed.a024800
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发表时间：
1998-12-01
期刊：
影响因子：
--
通讯作者：
Smith, GD
中科院分区：
文献类型：
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作者：
Ebrahim, S;Smith, GD
血压升高的危险因素包括肥胖、缺乏运动、高盐饮食摄入、压力和高酒精摄入。关于为预防疾病而改变这些危险因素对血压的影响，人们知之甚少。随机对照试验（RCTs）的系统回顾和荟萃分析进行估计各种非药物干预措施对血压的影响。方法RCTs的单一干预措施，旨在改变这些危险因素的成年人年龄在45岁或以上的高血压和无高血压，并至少有6个月的随访。以MEDLINE为主要来源，研究范围为1966年至1995年4月。结果多数RCT研究持续时间短，未提供疗效持续性的指导，被排除。总共有8项关于限盐的RCT，8项关于减肥的RCT，8项关于压力管理的RCT，8项关于运动的RCT，以及1项关于戒酒的RCT，持续时间超过6个月。（即干预-对照组）收缩压变化，平均mmHg（括号内为95%置信区间），限盐-2.9（-5.8，0.0）、减肥-5.2（-8.3，-2.0）、应激控制-1.0（-2.3，+0.3）、运动-0.8（-5.9，+4.2）。在血压正常的参与者中发现了较小的变化：盐限制-1.3（-2.7，+0.1），体重减轻-2.8（-3.9，-1.8），运动-0.2（-2.8，+2.4），酒精减少-2.1（-4.1，-0.1）。一些干预措施（例如，血压正常者的压力控制）未在高血压患者或血压正常者中进行检查。大多数RCT的方法学质量较低，偏倚往往会增加观察到的变化。少数的试验控制的混杂效应的并发变化，在其他血压riskfactors.Conclusion这些净变化可能是高估的效果，可能会实现非药物干预。有必要在高血压患者和血压正常人群中对这些非药物干预进行大规模、长时间的试验，以更准确地确定效应大小。
Background Risk factors for raised blood pressure include obesity, physical inactivity, high dietary salt intake, stress, and high alcohol consumption. Much less is known about the effects on blood pressure of modification of these risk factors for the purposes of disease prevention. A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to estimate the effects of various non-pharmacological interventions on blood pressure.Methods RCTs of single interventions aimed at altering these risk factors among adults aged 45 or older with and without hypertension, and with at least six months follow-up were included. MEDLINE was the primary source and the boundaries of the study were from 1966 to April 1995.Results The majority of RCTs were of short duration and did not provide guidance on the sustainability of effects and were excluded. Totals of eight RCTs of salt restriction, eight RCTs of weight reduction, eight of stress management, eight of exercise, and one of alcohol reduction of longer than six months duration were found. Net (i.e. intervention - control group) systolic blood pressure changes, mean mmHg (with 95 per cent confidence intervals in parentheses), in hypertensives were as follows: salt restriction -2.9 (-5.8, 0.0), weight loss -5.2 (-8.3, -2.0), stress control -1.0 (-2.3, +0.3), and exercise -0.8 (-5.9, +4.2). Smaller changes were found in normotensive participants: salt restriction -1.3 (-2.7, +0.1), weight loss -2.8 (-3.9, -1.8), exercise -0.2 (-2.8, +2.4), and alcohol reduction -2.1 (-4.1, -0.1). Some interventions (e.g. stress control in normotensives) were not examined in either hypertensives or normotensives. The majority of RCTs were of low methodological quality and bias often tended to increase the changes observed. Few of the trials controlled for the confounding effects of concurrent changes in other blood pressure risk factors.Conclusion These net changes are probably overestimates of the effects that might be achieved by non-pharmacological interventions. There is a need for large-scale, long duration trials of these non-pharmacological interventions in both hypertensive patients and normotensive people to determine effect sizes more accurately.