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      Efficacy and Safety of a Traditional Chinese Herbal Formula Xuefu Zhuyu Decoction for Hypertension : A Systematic Review and Meta-Analysis

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      Author(s): , MD, , MD, , MD
      Editor(s):
      Publication date (Electronic):
      Journal: Medicine
      Publisher: Wolters Kluwer Health

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          Abstract

          The cardioprotective role of xuefu zhuyu decoction (XZD), a well-known classical herbal formula, has been documented for hypertension treatment recently. This study aims to summarize the efficacy and safety of XZD in treating hypertension.

          Seven databases were searched to identify randomized controlled trials evaluating the efficacy of XZD in hypertensive patients. Fifteen studies involving 1364 hypertensive patients were included. All studies compared XZD and antihypertensive drugs with antihypertensive drugs used alone.

          In all, 15 studies reported significant effects of XZD for lowering blood pressure compared with the control group ( P < 0.05), and 7 studies reported significant effects of XZD for improving symptoms compared with the control group ( P < 0.00001). Meanwhile, studies reported XZD was more efficacious than antihypertensive drugs in improving total cholesterol, triglycerides, low-density lipoprotein cholesterol, homocysteine, hemorheology, carotid intima-media thickness, and left ventricular mass index ( P < 0.05). No severe adverse event was reported.

          This meta-analysis provides evidence that XZD is beneficial for hypertension. Although concerns regarding selective bias and methodologic flaws were raised, our findings suggests XZD as a new candidate cardioprotective drug for hypertension, which should be given priority for future preclinical and clinical studies.

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          Chronic kidney disease: effects on the cardiovascular system.

          Ernesto Schiffrin, Mark L. Lipman, Johannes Mann (2007)
          Accelerated cardiovascular disease is a frequent complication of renal disease. Chronic kidney disease promotes hypertension and dyslipidemia, which in turn can contribute to the progression of renal failure. Furthermore, diabetic nephropathy is the leading cause of renal failure in developed countries. Together, hypertension, dyslipidemia, and diabetes are major risk factors for the development of endothelial dysfunction and progression of atherosclerosis. Inflammatory mediators are often elevated and the renin-angiotensin system is frequently activated in chronic kidney disease, which likely contributes through enhanced production of reactive oxygen species to the accelerated atherosclerosis observed in chronic kidney disease. Promoters of calcification are increased and inhibitors of calcification are reduced, which favors metastatic vascular calcification, an important participant in vascular injury associated with end-stage renal disease. Accelerated atherosclerosis will then lead to increased prevalence of coronary artery disease, heart failure, stroke, and peripheral arterial disease. Consequently, subjects with chronic renal failure are exposed to increased morbidity and mortality as a result of cardiovascular events. Prevention and treatment of cardiovascular disease are major considerations in the management of individuals with chronic kidney disease.
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            Do certain countries produce only positive results? A systematic review of controlled trials.

            A. Vickers, N. Goyal, R. Harland … (1998)
            To determine whether clinical trials originating in certain countries always have positive results. Abstracts of trials from Medline (January 1966-June 1995). Two separate studies were conducted. The first included trials in which the clinical outcome of a group of subjects receiving acupuncture was compared to that of a group receiving placebo, no treatment, or a nonacupuncture intervention. In the second study, randomized or controlled trials of interventions other than acupuncture that were published in China, Japan, Russia/USSR, or Taiwan were compared to those published in England. Blinded reviewers determined inclusion and outcome and separately classified each trial by country of origin. In the study of acupuncture trials, 252 of 1085 abstracts met the inclusion criteria. Research conducted in certain countries was uniformly favorable to acupuncture; all trials originating in China, Japan, Hong Kong, and Taiwan were positive, as were 10 out of 11 of those published in Russia/USSR. In studies that examined interventions other than acupuncture, 405 of 1100 abstracts met the inclusion criteria. Of trials published in England, 75% gave the test treatment as superior to control. The results for China, Japan, Russia/USSR, and Taiwan were 99%, 89%, 97%, and 95%, respectively. No trial published in China or Russia/USSR found a test treatment to be ineffective. Some countries publish unusually high proportions of positive results. Publication bias is a possible explanation. Researchers undertaking systematic reviews should consider carefully how to manage data from these countries.
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              Effects of yoga on cardiovascular disease risk factors: a systematic review and meta-analysis.

              Holger Cramer, Romy Lauche, Heidemarie Haller … (2014)
              The aim of this review was to systematically assess and meta-analyze the effects of yoga on modifiable biological cardiovascular disease risk factors in the general population and in high-risk disease groups. MEDLINE/PubMed, Scopus, the Cochrane Library, and IndMED were screened through August 2013 for randomized controlled trials (RCTs) on yoga for predefined cardiovascular risk factors in healthy participants, non-diabetic participants with high risk for cardiovascular disease, or participants with type 2 diabetes mellitus. Risk of bias was assessed using the Cochrane risk of bias tool. Forty-four RCTs with a total of 3168 participants were included. Risk of bias was high or unclear for most RCTs. Relative to usual care or no intervention, yoga improved systolic (mean difference (MD)=-5.85 mm Hg; 95% confidence interval (CI)=-8.81, -2.89) and diastolic blood pressure (MD=-4.12 mm Hg; 95%CI=-6.55, -1.69), heart rate (MD=-6.59 bpm; 95%CI=-12.89, -0.28), respiratory rate (MD=-0.93 breaths/min; 95%CI=-1.70, -0.15), waist circumference (MD=-1.95 cm; 95%CI=-3.01, -0.89), waist/hip ratio (MD=-0.02; 95%CI=-0.03, -0.00), total cholesterol (MD=-13.09 mg/dl; 95%CI=-19.60, -6.59), HDL (MD=2.94 mg/dl; 95%CI=0.57, 5.31), VLDL (MD=-5.70 mg/dl; 95%CI=-7.36, -4.03), triglycerides (MD=-20.97 mg/dl; 95%CI=-28.61, -13.32), HbA1c (MD=-0.45%; 95%CI=-0.87, -0.02), and insulin resistance (MD=-0.19; 95%CI=-0.30, -0.08). Relative to exercise, yoga improved HDL (MD=3.70 mg/dl; 95%CI=1.14, 6.26). This meta-analysis revealed evidence for clinically important effects of yoga on most biological cardiovascular disease risk factors. Despite methodological drawbacks of the included studies, yoga can be considered as an ancillary intervention for the general population and for patients with increased risk of cardiovascular disease. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Medicine (Baltimore)
                Journal ID (iso-abbrev): Medicine (Baltimore)
                Journal ID (publisher-id): MEDI
                Title: Medicine
                Publisher: Wolters Kluwer Health
                ISSN (Print): 0025-7974
                ISSN (Electronic): 1536-5964
                Publication date Collection: October 2015
                Publication date (Electronic): 23 October 2015
                Volume: 94
                Issue: 42
                Electronic Location Identifier: e1850
                Affiliations
                From the Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China (PW); Department of Cardiology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China (XX); and Department of Biological Science and Technology, School of Life Sciences, Tsinghua University, Beijing, China (SL).
                Author notes
                Correspondence to Xingjiang Xiong, MD, Department of Cardiology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beixiange 5#, Xicheng District, Beijing 100053, China (e-mail: xiongxingjiangtcm163.com or 5administration@ 123456163.com ).
                Article
                Accession ID: 01850
                DOI: 10.1097/MD.0000000000001850
                PMC ID: 4620751
                PubMed ID: 26496333
                SO-VID: 7b79151f-06d7-438c-b289-2c5ff64c67f3
                Copyright © Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
                License:

                This is an open access article distributed under the Creative Commons Attribution License 4.0, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0

                History
                Date received : 4 September 2015
                Date revision received : 23 September 2015
                Date accepted : 26 September 2015
                Categories
                Subject: 3800
                Subject: Research Article
                Subject: Systematic Review and Meta-Analysis
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                OPEN-ACCESS TRUE

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