Traditional Chinese Medicine for Essential Hypertension: An Overview of Systematic Reviews_Chinese Journal of Evidence-Based Medicine

Authors：

 YANGYan-tao ¹ ,  MALi ¹ , YANGXiao-xia ¹ , ZHAOChun-xiang ²

1. First People's Hospital of Lanzhou, Lanzhou 730050, China;
2. People's Hospital of Gaolan of Lanzhou, Lanzhou 730050, China;

Corresponding author：

MALi, Email: flykikimary@163.com

Keywords：

Traditional Chinese medicine; Essential hypertension; Overview of systematic review; GRADE system

DOI：

10.7507/1672-2531.20140175

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To evaluate the methodological bias and the reliability of the conclusions of systematic reviews (SRs) about traditional Chinese medicine for essential hypertension. Methods We comprehensively searched PubMed, EMbase, The Cochrane library (Issue 4, 2014), CBM, CNKI and WanFang Data to collect SRs of traditional Chinese medicine for essential hypertension from the establishment time of databases to April 30th, 2014. The AMSTAR tool was applied for methodological quality assessment of included studies, and the GRADE system was applied for evidence quality assessment of included outcomes of SRs. Results A total of 12 SRs involving 31 outcomes were included, of which 11 SRs focused on the comparison of therapeutic effects between traditional Chinese medicine combined with western medicine and western medicine alone. Nine SRs adopted Jadad tool to assess methodological quality of included original studies. The results of assessment using AMSTAR showed that, among 11 items, there were the most problems concerning Item 1 "Was an 'a prior' design provided?" (none of the 12 SRs provided it); followed by Item 11 "Were potential conflict of interest included?" (nine SRs didn't described it), and Item 6 "Were the characteristics of included studies provided" (six SRs didn't provided it). The results of grading showed that, 29 outcomes were graded as "low" or "very low" quality. The main factors contributed to downgrading evidence quality were limitations (31 outcomes), followed by imprecision (12 outcomes), and inconsistency (13 outcomes). Conclusion Currently, the methodological quality of SRs about traditional Chinese medicine for essential hypertension was poor on the whole, with low quality of evidence as well as lack of enough attention to the end outcomes of patients with essential hypertension. Thus, physicians should apply the evidence to make decision about traditional Chinese medicine for essential hypertension with caution in clinical practice.

Citation： YANGYan-tao, MALi, YANGXiao-xia, ZHAOChun-xiang. Traditional Chinese Medicine for Essential Hypertension: An Overview of Systematic Reviews. Chinese Journal of Evidence-Based Medicine, 2014, 14(9): 1070-1076. doi: 10.7507/1672-2531.20140175 Copy

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2.	陆再英, 钟南山.内科学.北京:人民卫生出版社, 2008:251.
3.	Kearney PM, Whelton M, Reynolds K, et al. Global burden of hypertension:analysis of worldwide data. Lancet, 2005, 365(9455):217-223.
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5.	中国高血压防治指南修订委员会.中国高血压防治指南2010.中华心血管病杂志, 2011, 39(7):579-616.
6.	王宁.原发性高血压的发病机制与临床治疗.中国医药指南, 2013, (33):570-571.
7.	于汇民, 王兵, 刘国仗, 等.原发性高血压的病因及发病机制.新医学, 2003, 34(3):135-136.
8.	杨克虎, 刘雅莉, 袁金秋, 等.发展和完善中的系统评价再评价.中国循证儿科杂志, 2011, 6(1):54-57.
9.	刘雅莉, 袁金秋, 杨克虎, 等.系统评价再评价的制作方法简介及相关资料分析.中国循证儿科杂志, 2011, 6(1):58-64.
10.	Chobanian AV, Bakris GL, Black HR, et al. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure:the JNC 7 report. JAMA, 2003, 289(19):2560-2571.
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12.	GRADE Working Group. Grading quality of evidence and strength of recommendations. BMJ, 2004, 328(7454):1490.
13.	曾宪涛, 冷卫东, 李胜, 等.如何正确理解及使用GRADE系统.中国循证医学杂志, 2011, 11(9):985-990.
14.	陈新宇, 尹玲珑, 刘紫轩, 等.半夏白术天麻汤治疗原发性高血压临床疗效Meta分析.辽宁中医杂志, 2014, 41(2):196-199.
15.	王琼.丹参注射液治疗高血压脑出血疗效与安全性的Meta分析.浙江大学, 2012.
16.	郭意欣, 陈新林, 丘振文, 等.六味地黄丸联合西药治疗高血压病的Meta分析和系统评价.中国中医急症, 2013, 22(2):189-191.
17.	周倩仪, 马楷奇, 郭意欣, 等.天麻钩藤饮联合卡托普利治疗原发性高血压的系统评价和Meta分析.安徽中医学院学报, 2013, 32(4):12-17.
18.	董大幸, 姚松林, 余男, 等.天麻钩藤饮联合依那普利治疗原发性高血压系统评价和Meta分析.中国中医急症, 2011, 20(5):762-764.
19.	任毅, 欧爱华, 林晓忠.中医药治疗原发性高血压随机对照试验的Meta分析.陕西中医, 2006, 27(7):794-796.
20.	戴娟.中医药治疗原发性高血压的系统评价.中国中医药咨讯, 2010, 2(36):22-24.
21.	杜浩, 戴小华.养血清脑颗粒治疗高血压伴随症状的Meta分析.安徽中医药大学学报, 2014, 33(1):8-11.
22.	李东娜, 杨传华.中医药治疗老年单纯收缩期高血压临床疗效的Meta分析.辽宁中医杂志, 2012, 39(5):812-815.
23.	Xiong X, Yang X, Liu W, et al. Banxia Baizhu Tianma Decoction for Essential Hypertension:A Systematic Review of Randomized Controlled Trials. Evid Based Complement Alternat Med, 2012, 2012:271462.
24.	Wang J, Feng B, Yang X, et al. Tianma gouteng yin as adjunctive treatment for essential hypertension:systematic review of randomizedcontrolled trials. Evid Based Complement Alternat Med, 2013, 2013:706125.
25.	Wu X, Jiang X. Systematic review and meta-analysis of randomized controlled trials on Tianmagouteng decoction in treatment of primary hypertension with liver Yang hyperactivity syndrome. J Tradit Chin Med, 2013, 33(1):15-18.
26.	Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0[updated March 2011]. The Cochrane Collaboration, 2011.
27.	Shea BJ, Grimshaw JM, Wells GA, et al. Development of AMSTAR:a measurement tool to assess the methodological quality of systematic reviews. BMC Medical Research Methodology, 2007, 7(1):10.
28.	郭新峰, 赖世隆.对中医药领域开展循证医学研究的几点看法.中国循证医学杂志, 2008, 8(1):10-12.
29.	王俊文, 崔蒙, 赵英凯, 等.中医药领域循证医学发展建议.世界中医药, 2010, 05(5):305-307.
30.	李静, 李幼平.不断完善与发展的Cochrane系统评价.中国循证医学杂志, 2008, 8(9):742-743.
31.	Jadad AR, Cook DJ, Jones A. Methodology and reports of systematic reviews and meta-analysis:a comparison of Cochrane paper-based journals. JAMA, 1998, 280(3):278-280.
32.	郭新峰, 朱泉, 赖世隆.替代指标和中间指标及其在中医药疗效评价研究中应用价值的思考.中国中西医结合杂志, 2005, 25(7):585-590.
33.	Oliver MF, Heady JA, Morris JN, et al. For the Committeeof Principal Investigators. WHO cooperative trial of primary prevention of ischemic heart disease with clofibrate to lower serum cholesterol:final mortality follow-up. Lancet, 1984, 2:600-604.

1. 易秋, 艳张, 林潮.原发性高血压流行病学研究进展.中华高血压杂志, 2010, 18(9):823-826.
2. 陆再英, 钟南山.内科学.北京:人民卫生出版社, 2008:251.
3. Kearney PM, Whelton M, Reynolds K, et al. Global burden of hypertension:analysis of worldwide data. Lancet, 2005, 365(9455):217-223.
4. 中华人民共和国卫生部.中国居民营养与健康状况.中国心血管病研究杂, 2004, 2(12):919-922.
5. 中国高血压防治指南修订委员会.中国高血压防治指南2010.中华心血管病杂志, 2011, 39(7):579-616.
6. 王宁.原发性高血压的发病机制与临床治疗.中国医药指南, 2013, (33):570-571.
7. 于汇民, 王兵, 刘国仗, 等.原发性高血压的病因及发病机制.新医学, 2003, 34(3):135-136.
8. 杨克虎, 刘雅莉, 袁金秋, 等.发展和完善中的系统评价再评价.中国循证儿科杂志, 2011, 6(1):54-57.
9. 刘雅莉, 袁金秋, 杨克虎, 等.系统评价再评价的制作方法简介及相关资料分析.中国循证儿科杂志, 2011, 6(1):58-64.
10. Chobanian AV, Bakris GL, Black HR, et al. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure:the JNC 7 report. JAMA, 2003, 289(19):2560-2571.
11. Shea BJ, Grimshaw JM, Wells GA, et al. Development of AMSTAR:a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol, 2007, 7:10.
12. GRADE Working Group. Grading quality of evidence and strength of recommendations. BMJ, 2004, 328(7454):1490.
13. 曾宪涛, 冷卫东, 李胜, 等.如何正确理解及使用GRADE系统.中国循证医学杂志, 2011, 11(9):985-990.
14. 陈新宇, 尹玲珑, 刘紫轩, 等.半夏白术天麻汤治疗原发性高血压临床疗效Meta分析.辽宁中医杂志, 2014, 41(2):196-199.
15. 王琼.丹参注射液治疗高血压脑出血疗效与安全性的Meta分析.浙江大学, 2012.
16. 郭意欣, 陈新林, 丘振文, 等.六味地黄丸联合西药治疗高血压病的Meta分析和系统评价.中国中医急症, 2013, 22(2):189-191.
17. 周倩仪, 马楷奇, 郭意欣, 等.天麻钩藤饮联合卡托普利治疗原发性高血压的系统评价和Meta分析.安徽中医学院学报, 2013, 32(4):12-17.
18. 董大幸, 姚松林, 余男, 等.天麻钩藤饮联合依那普利治疗原发性高血压系统评价和Meta分析.中国中医急症, 2011, 20(5):762-764.
19. 任毅, 欧爱华, 林晓忠.中医药治疗原发性高血压随机对照试验的Meta分析.陕西中医, 2006, 27(7):794-796.
20. 戴娟.中医药治疗原发性高血压的系统评价.中国中医药咨讯, 2010, 2(36):22-24.
21. 杜浩, 戴小华.养血清脑颗粒治疗高血压伴随症状的Meta分析.安徽中医药大学学报, 2014, 33(1):8-11.
22. 李东娜, 杨传华.中医药治疗老年单纯收缩期高血压临床疗效的Meta分析.辽宁中医杂志, 2012, 39(5):812-815.
23. Xiong X, Yang X, Liu W, et al. Banxia Baizhu Tianma Decoction for Essential Hypertension:A Systematic Review of Randomized Controlled Trials. Evid Based Complement Alternat Med, 2012, 2012:271462.
24. Wang J, Feng B, Yang X, et al. Tianma gouteng yin as adjunctive treatment for essential hypertension:systematic review of randomizedcontrolled trials. Evid Based Complement Alternat Med, 2013, 2013:706125.
25. Wu X, Jiang X. Systematic review and meta-analysis of randomized controlled trials on Tianmagouteng decoction in treatment of primary hypertension with liver Yang hyperactivity syndrome. J Tradit Chin Med, 2013, 33(1):15-18.
26. Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0[updated March 2011]. The Cochrane Collaboration, 2011.
27. Shea BJ, Grimshaw JM, Wells GA, et al. Development of AMSTAR:a measurement tool to assess the methodological quality of systematic reviews. BMC Medical Research Methodology, 2007, 7(1):10.
28. 郭新峰, 赖世隆.对中医药领域开展循证医学研究的几点看法.中国循证医学杂志, 2008, 8(1):10-12.
29. 王俊文, 崔蒙, 赵英凯, 等.中医药领域循证医学发展建议.世界中医药, 2010, 05(5):305-307.
30. 李静, 李幼平.不断完善与发展的Cochrane系统评价.中国循证医学杂志, 2008, 8(9):742-743.
31. Jadad AR, Cook DJ, Jones A. Methodology and reports of systematic reviews and meta-analysis:a comparison of Cochrane paper-based journals. JAMA, 1998, 280(3):278-280.
32. 郭新峰, 朱泉, 赖世隆.替代指标和中间指标及其在中医药疗效评价研究中应用价值的思考.中国中西医结合杂志, 2005, 25(7):585-590.
33. Oliver MF, Heady JA, Morris JN, et al. For the Committeeof Principal Investigators. WHO cooperative trial of primary prevention of ischemic heart disease with clofibrate to lower serum cholesterol:final mortality follow-up. Lancet, 1984, 2:600-604.

Chinese Journal of Evidence-Based Medicine

Traditional Chinese Medicine for Essential Hypertension: An Overview of Systematic Reviews

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