ObjectivesTo evaluate the efficacy and safety of newer-generation antidepressants for patients with myocardial infarction (MI) and depression.MethodsPubMed, The Cochrane Library, EMbase, Web of Science, CBM, CNKI, WanFang Data, and VIP databases were searched from inception to December 2017 to collect randomized controlled trials (RCT) on newer-generation antidepressants for patients with MI and depression. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software.ResultsTen RCTs involving 552 participants were included. The results showed that the antidepressant group was superior to the placebo or treatment group in terms of the improvement of depressive symptoms (SMD=–1.38, 95%CI –1.93 to –0.82, P<0.000 01), and incidence of angina (RR=0.42, 95%CI 0.25 to 0.71,P=0.001), recurrent MI (RR=0.43, 95%CI 0.22 to 0.83, P=0.01), and re-hospitalization for cardiac reasons (RR=0.51, 95%CI 0.28 to 0.92, P=0.03). However, there were no significant differences between two groups on all-cause mortality (RR=0.45, 95%CI 0.18 to 1.11, P=0.08), cardiovascular mortality (RR=0.53, 95%CI 0.16 to 1.73, P=0.29) and incidence of heart failure (RR=0.75, 95%CI 0.39 to 1.43, P=0.38). Subgroup analysis revealed that the type of antidepressants could affect the improvement of depression outcome. Citalopram and fluoxetine might be the most effective drugs for patients with MI and depression.ConclusionsNewer-generation antidepressants are effective for treatment of depressive symptoms in patients with MI and depression, with no significant impact on all-cause mortality and cardiovascular mortality. Moreover, antidepressants can reduce the incidence of angina, recurrent MI, and re-hospitalization for cardiac reasons in patients suffering from MI and depression. Due to limited quantity and quality of included studies, more high quality studies are required to verify above conclusions.
Background and Aim Morbidity due to hypertension morbidity is increasing in the Chinese population, and the blood pressure control rate is low. The aim of this trial is to optimize the hypertension treatment plan, promote blood pressure goals and reduce cardio-cerebrovascular events. Objective and Methods Patients are eligible for inclusion if they are diagnosed with essential hypertension, aged 50-79 years with at least one cardiovascular risk factor and sign the consent forms. This project is a multi-centre, randomized, controlled and blind-endpoint trial. 12 000 patients will be randomly assigned to low-dose Amlodipine and Telmisartan or Amlodipine and diuretics. Patients whose blood cholesterol is between 4.0-6.1mmol/L will also be randomized into small dose of statin-based regimen or standard management regimen; and patients will be randomly assigned to intensive lifestyle intervention group or standard intervention group according to the community area where they live. The primary study outcome is a composite of non-fatal stroke/myocardial infarction and cardiovascular death. Patients will be followed-up for 4 years. Expected Results The cumulative primary outcome is estimated to be 500 cases, and the hypertension control rate is expected to reach 70%. Cardiovascular events are expected to be reduced by 20% in the optimized treatment group and poor lifestyle will be markedly improved. A total of 150 clinical centres in China will join in the study, which will be completed at the end of 2011.