Herbal Medicine (Sihogayonggolmoryeo-Tang or Chai-Hu-Jia-Long-Gu-Mu-Li-Tang) for Treating Hypertension:A Systematic Review and Meta-Analysis

Preference between Chinese and Western medicines for hypertension treatment: Evidences based on Chinese population aged ≥ 45 years

Hypertension is one of the chronic diseases that threaten the health of the elderly population. This study aims to explore the treatment and medication preferences in Chinese elderly patients (≥45 years old) with hypertension, and to investigate the relevant influencing factors. A cross-sectional design was adopted. Utilizing the data from the public database CHARLS 2018, the factors influencing the treatment and medication preference among the elderly hypertensive patients were explored with multinomial logistic regression models. A total of 6588 hypertensive patients aged ≥ 45 years were included in this study, of which 5135 (77.94%) received treatment. Besides, 4939 (96.18%) chose oral medication, which was the most preferred treatment for these patients. The proportion of patients who chose "oral medication only" increased with age, but decreased with educational level and self-reported health. Patients with higher educational levels were more likely to choose other modalities of treatment. In particular, patients with better self-reported health were more willing to try traditional Chinese medication (TCM). Lower income group without medical insurance preferred to choose "Chinese medicine only." Patients aged ≥ 75 years, urban residents, and those with 2 or more chronic diseases were more willing to try combined Chinese and Western medicines. Patients' preference for TCM therapy was correlated positively with the provincial economic welfare factor, and negatively with the provincial medical and social welfare factors. During treatment of patients with hypertension, clinicians should pay attention to their preferences and formulate personalized regimens for them, in order to improve their compliance with treatment. Additionally, the government should steadily improve the local medical benefits, thereby facilitating the promotion and application of local TCM services.

Metabolomic characteristics of spontaneously hypertensive rats under chronic stress and the treatment effect of Danzhi Xiaoyao Powder, a traditional Chinese medicine formula

OBJECTIVE

Numerous studies have demonstrated the close relationship between chronic stress and blood pressure (BP). Hypertensive subjects exhibit exaggerated reactions to stress, especially higher BP. The mechanisms by which stress affects pre-existing hypertension still need to be explored. Danzhi Xiaoyao Powder (DP), a historical traditional Chinese medicine formula, is a promising treatment for BP control in hypertensive patients under stress. The present study investigated the metabolomic disruption caused by chronic stress and the treatment effect and mechanism of DP.

METHODS

Spontaneously hypertensive rats (SHRs) were subjected to chronic restraint stress (CRS) for 4 weeks. BP was measured via the tail-cuff method, and anxiety-like behavior was quantified using the elevated-plus-maze test. Meanwhile, DP was administered intragastrically, and its effects were observed. Global metabolomic analysis was performed using ultra-high-performance liquid chromatography-quadrupole time-of-flight mass spectrometry, followed by multivariate statistical analysis to detect differential metabolites and pathways.

RESULTS

DP alleviated the CRS-induced increase in BP and anxiety-like behavior. Systematic metabolic differences were found among the three study groups. A total of 29 differential plasma metabolites were identified in both positive- and negative-ion modes. These metabolites were involved in triglyceride metabolism, amino acid (phenylalanine, tryptophan, and glycine) metabolism, and steroid hormone pathways.

CONCLUSION

These findings expose the metabolomic disturbances induced by chronic stress in SHRs and suggest an innovative treatment for this disorder.

Methodological Aspects of Meta-Analyses Assessing the Effect of Blood Pressure-Lowering Treatment on Clinical Outcomes

Systematic reviews and meta-analyses are often considered the highest level of evidence, with high impact on clinical practice guidelines. The methodological literature on systematic reviews and meta-analyses is extensive and covers most aspects relevant to the design and interpretation of meta-analysis findings in general. Analyzing the effect of blood pressure-lowering on clinical outcomes poses several challenges over and above what is covered in the general literature, including how to combine placebo-controlled trials, target-trials, and comparative studies depending on the research question, how to handle the potential interaction between baseline blood pressure level, common comorbidities, and the estimated treatment effect, and how to consider different magnitudes of blood pressure reduction across trials. This review aims to address the most important methodological considerations, to guide the general reader of systematic reviews and meta-analyses within our field, and to help inform the design of future studies. Furthermore, we highlight issues where published meta-analyses have applied different analytical strategies and discuss pros and cons with different strategies.