Meta-analysis Of Clinical Randomized Controlled Trials Of Traditional Physical Exercise Combined With Antihypertensive Drugs In The Treatment Of Hypertension

ObjectivesUsing network meta-analysis method to evaluate the effect of Tai Chi,Baduanjin,Wuqinxi,or yoga combined with antihypertensive medications in the treatment of hypertension patients in randomized controlled trials(RTCs).The observed outcome was the lowering of office blood pressure and ambulatory blood pressure.MethodsCNKI,Wanfang Data,VIP database,SinoMed,PubMed,Cochrane,and Embase were screened through August 2020 for randomized controlled trials(RCTs)on Tai Chi,Baduanjin,Wuqinxi and yoga combined with antihypertensive medications in the treatment of essential hypertension.According to the pre-specified inclusion criteria and exclusion criteria,the literature was screened and relevant information was extracted,and then the risk of bias tool(RoB)was used to evaluate the quality of the literature,and statistical software such as Stata and GeMTC was used to conduct network meta-analysis.Results1.Retrieval and screening results found a total of 1595 related studies.Finally include 31 RCTs that met the inclusion criteria and exclusion criteria,including 2146 patients with hypertension,all of which were dual-arm trials involving 6 interventions.They were:Tai Chi with antihypertensive medications(TJQ+AHM),Baduanjin with antihypertensive medications(BDJ+AHM),Wuqinxi with antihypertensive medications(WQX+AHM),yoga with antihypertensive medications(YJ+AHM),walking with antihypertensive medications(Walk+AHM),and the use of antihypertensive medications(AHM)alone.2.The risk of bias assessment of the included studies among the 31 studies,15 studies(48.4%)reported the correct random allocation method;5 studies(16.1%)adopted a perfect allocation hiding scheme;5 studies(16.1%)used blinding method,but due to intervention measures,all the studies could not blind the participants;28 studies(90.3%)did not have participants withdraw or although some participants withdrew,the reasons and proportions of dropouts were kept in balance;1 study(3.2%)provided registration information before theexperiment.3.Network meta-analysis results of blood pressure monitoring in the office(involving all 6 interventions)① The four traditional exercises combined with antihypertensive medications have statistically different interventions compared with Walk+AHM or AHM.SUCRA ranks the four traditional exercise programs combined with antihypertensive medications in probability order:It is suggested that traditional exercise programs such as Baduanjin,Taijiquan,Wuqinxi,yoga and other traditional exercise programs combined with antihypertensive medications interfere with hypertension.Antihypertensive medications,or walking combined with antihypertensive medications,and in the order of superiority in reducing SBP,the highest probability is WQX+AHM,followed by YJ+AHM,BDJ+AHM and TJQ+AHM.②Diastolic blood pressure(DBP):There are statistical differences between AHM,and four traditional exercise programs combined with antihypertensive medications,while Walk+AHM is only statistically different from BDJ+AHM and WQX+AHM.SUCRA prompts:To reduce the superiority of DBP,the highest probability is WQX+AHM,followed by BDJ+HAM,YJ+AHM and TJQ+AHM4.Network meta-analysis results of ambulatory blood pressure monitoring:4 intervention measures are involved,namely TJQ+AHM,BDJ+AHM,YJ+AHM,and AHM.There is no statistical difference between the two interventions.In the order of each sub-item,the intervention of YJ+AHM may be less effective than AHM.In addition,①24-hour blood pressure(including SBP and DBP)average:the highest probability is TJQ+AHM,followed by BDJ+AHM;② Mean daytime SBP:the highest probability is BDJ+AHM,followed by TJQ+AHM;③ Mean daytime DBP:the highest probability is TJQ+AHM,followed by BDJ+AHM;④Mean nocturnal SBP and mean nocturnal DBP:the highest probability is BDJ+AHM.5.Only 3 of the 31 included studies recorded the occurrence of adverse events,one of which was considered irrelevant to the intervention after analysis by the original author;the other reported that the adverse event may be related to the intervention,but the duration was short;one article reported that the incidence of adverse events during the one-year follow-up period was lower than that of the control group.ConclusionCompared with the simple application of antihypertensive medications or antihypertensive medications combined with walking,traditional exercise combined with antihypertensive medications have a better and safer effect on lowering blood pressure.In terms of antihypertensive effects,Wuqinxi combined with antihypertensive medications has the greatest probability of being the best choice,followed by yoga combined antihypertensive medications,Baduanjin combined antihypertensive medications,and Tai Chi combined antihypertensive medications.