A Meta-analysis And Retrospective Study Of Decoctions Of Traditional Chinese Medicine In The Treatment Of Essential Hypertension

Part I:Meta-analysis on the treatment of essential hypertension with traditional Chinese medicine decoctionObjective:Using Meta-analysis to evaluate the comprehensive efficacy,safety,and medication patterns of traditional Chinese medicine decoction in the treatment of essential hypertension(EH),and provide certain evidence-based medical evidence for the clinical treatment of EH with traditional Chinese medicine decoction.Methods:A comprehensive computer search was conducted for all documents related to the treatment of EH with traditional Chinese medicine decoction from the beginning of the database establishment to June 2022 in databases such as CNKI,VIP,Wanfang Database,China Biomedical Database,PubMed,Cochrane Library,Embase,and Web of Science.The retrieved literature was screened,the final included articles were assessed for quality using the Cochrane Evaluation Handbook,and finally the RevMan 5.4.1 software was used for data analysis.Results:This study included a total of 27 articles,published from 2013 to 2022,with a total of 3337 patients,including 1668 in the experimental group and 1669 in the control group.A Meta-analysis was conducted on the final included literature,and the following results were obtained:1.Clinical efficacy:A total of 27 articles meeting the criteria were included,with a combined effect amount of I2=0%,RR=1.18,95%CI=[1.15,1.22],P<0.0001,with a statistically significant difference,indicating that the efficacy is better than using western medicine alone.2.SBP and DBP:A total of 27 articles that met the criteria were included,and statistical tests found that there was great heterogeneity.Sensitivity analyses and subgroup analyses did not identify source of heterogeneity,and descriptive analysis alone cannot reach reliable conclusions.3.TCM symptom scores:Four articles were included,and statistical tests found significant heterogeneity.Sensitivity analysis:After removing each study item by item,it was found that after removing one study,the heterogeneity significantly decreased,and the combined effect amount was I2=27%,SMD=-1.09,95%CI=[-1.31,-0.88],Z=9.99,P<0.00001.The results showed that there is a statistically significant difference in the TCM symptom scores between the experimental group and the control group,which can be considered to have a significant therapeutic effect compared to simple western medicine treatment.4.ET-1,NO:A total of 5 articles meeting the criteria were included,and statistical tests found that there was great heterogeneity.Sensitivity analysis did not identify sources of heterogeneity.Therefore,the combined analysis was abandoned,and descriptive analysis alone cannot reach reliable conclusions.5.Adverse reactions:A total of 9 articles meeting the criteria were included,and statistical tests found that the heterogeneity was small.Combined effect amount I2=43%<50%,RR=0.63,95%CI=[0.45,0.87],P=0.006<0.05.The difference is statistically significant,indicating that compared to simple western medicine treatment,traditional Chinese medicine decoction treatment of EH patients has fewer adverse reactions and higher safety.6.In the 27 articles included,the main TCM used were Rhizoma Gastrodiae,Achyranthes bidentata(21 times),Eucommia ulmoides(19 times),Uncaria hook,Morus parasiticus(18 times),Scutellaria baicalensis(17 times),Concha haliotidis,Tuber Fleeceflower Stem(16 times),Gardenia jasminoides(15 times),Motherwort(12 times),Fushen(10 times),Peony bark,Glycyrrhiza uralensis,Alisma orientalis(6 times),the fruit of Chinese wolfberry,dragon bone,oyster,cornus officinalis(5 times),and other traditional Chinese medicines for calming the liver and suppressing yang,clearing damp and promoting diuresis.7.Literature quality analysisAfter evaluating the quality of the 27 included literatures,13 articles described specific random allocation methods in the main text or abstract,and another 13 articles mentioned the use of random grouping in the text,with only one article not specifically described.In terms of report results data,most of the research results have relatively complete data.However,most studies have not provided specific explanations on the implementation of blinding methods and case dropouts,and the quality of literature is generally low,resulting in low authenticity and credibility of research results.Conclusion:1.The clinical efficacy and TCM symptom scores in the treatment of EH with traditional Chinese medicine decoction are superior to the basic treatment of western medicine alone.In terms of improving the levels of SBP,DBP,and ET-1,reliable conclusions cannot be drawn solely through descriptive analysis.In terms of improving NO,there was no significant difference compared to the conventional Western medicine treatment group.2.In terms of adverse reactions in the treatment of EH with traditional Chinese medicine decoction,it is shown that compared with simple western medicine treatment,traditional Chinese medicine decoction has fewer adverse reactions and higher safety in the treatment of EH patients.3.The included literature involves a total of 64 drugs,with the higher frequency of use being Rhizoma Gastrodiae,Achyranthes bidentata,Eucommia ulmoides,Uncaria hook,Morus parasiticus,Scutellaria baicalensis,Concha haliotidis,Tuber Fleeceflower Stem,Gardenia jasminoides,Motherwort,Fushen,Peony bark,Glycyrrhiza uralensis,Alisma orientalis,etc.Part Ⅱ:Retrospective study on the treatment of essential hypertension with traditional Chinese medicine decoctionObjective:Through retrospective study analyzing the clinical data of EH patients treated with traditional Chinese medicine decoction in the Cardiovascular Department of the First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine from January 2021 to December 2022.Summarizing the onset characteristics and medication patterns of EH patients,in order to provide data support for the treatment of EH with traditional Chinese medicine decoction.Methods:The medical records of 176 EH patients were recorded and analyzed,counting the age,gender,personal history,family history,course of disease,onset solar term,basic diseases,tongue and pulse,TCM syndrome types,hypertension classification,frequency of traditional Chinese medicine use,frequency of basic prescription use,etc.Organizing and analyzing the clinical data in Excel,and finally use SPSS 25.0 software to analyze the data to obtain the clinical onset characteristics and medication characteristics of inpatients.Results:1.General situation:Among 176 patients with essential hypertension,there are 82 males and 94 females,with slightly more females than males.The majority of them are aged between 56 and 65.After statistical testing,there is no statistical difference between the sexes(P>0.05).The majority of patients have a disease course of 5-10 years,with an average longer course.2.Statistical analysis of the onset solar terms of 176 patients showed that there were 32 cases in summer,50 cases in spring,39 cases in autumn,and 55 cases in winter.The hospitalization rate of hypertensive patients in winter(31.25%)was higher than that in the other three seasons.According to the classification of the 24 solar terms,the higher frequency ones are Xiaohan,Jingzhe,and Winter Solstice.3.Among the 176 patients included in this study,65(36.93%)had a history of smoking,79(44.89%)had a history of drinking,and 87(49.43%)had a family history of hypertension.4.In terms of basic diseases,the top three are cerebrovascular disease,coronary heart disease and diabetes.5.Tongue pulse condition:A total of 7 types of tongue were identified in 176 patients,ranked in order of frequency as light purple tongue,red tongue,and purple dark tongue.There are a total of 8 types of tongue coating,with thin white coating,white greasy coating,and yellow coating being the most common;There are 15 types of pulse patterns,including taut pulse,deep pulse,and fine pulse.6.Classification of hypertension:21 people(11.93%)with hypertension grade I,61 people(34.66%)with hypertension grade Ⅱ,and 94 people(53.41%)with hypertension grade Ⅲ.7.Distribution of TCM syndromes:57 cases(32.39%)of phlegm and blood stasis syndrome,53 cases(30.11%)of liver and kidney deficiency syndrome,45 cases(25.57%)of yin deficiency and yang hyperactivity syndrome,and 21 cases(11.93%)of liver fire inflammation syndrome.According to the classification and distribution of hypertension in various TCM syndromes,the number of cases of hyperactivity of liver fire syndrome in patients with hypertension of grade Ⅰ is up to 11.The maximum number of cases of yin deficiency and yang hyperactivity syndrome in patients with hypertension grade Ⅱ is 25.The syndrome of phlegm and blood stasis in patients with hypertension of grade Ⅲ is the most common in 41 cases.8.The prescriptions included in this study included a total of 114 traditional Chinese medicines,and the top 60 herbs with higher frequency of use were identified.Among them,Angelica sinensis,Jujube,and Atractylodes macrocephala are more frequently used in tonifying herbs;Herbs for calming the liver and calming the wind:Gastrodia elata,Uncaria Hook,Concha haliotidis;Heat clearing herbs:Peony bark,red peony,and Scutellaria baicalensis;Herbs for clearing damp and promoting diuresis:Poria cocos,Motherwort,and Alisma orientalis;Blood-activating and Stasiseliminating Drugs:Ligusticum wallichii,peach kernel,Achy-ranthes bidentata;Qi regulating drugs:bergamot,cyperus rotundus,and Fructus Toosendan;Phlegm resolving,cough relieving,and asthma relieving drugs:Pinellia ternata,tangerine peel,and platycodon grandiflorum;Tranquilizer:Tuber fleeceflower stem,Fu Shen,Semen Platycladi,etc.9.Treatment:A total of 208 prescriptions were included in this study,including Liuwei Dihuang Pill,Qiju Dihuang Pill,Yougui Pill,Banxia B aizhu Tianma Decoction and Tongqiao Huoxue Decoction,Xuefu Zhuyu Decoction,Tianma Gouteng Yin,Tiaogan Jiangya Decoction,Longdan Xiegan Decoction,etc.Conclusion:1.Among EH patients,female patients are slightly more than male patients.In winter and spring,the number of patients is higher,and the general course of disease is longer.Most patients have cerebrovascular disease,coronary heart disease,and diabetes.There are many people who smoke and drink,and nearly half of the patients have a family history of hypertension,suggesting that bad habits and genetic factors such as smoking and drinking are closely related to the disease.2.The tongue texture is mainly composed of a light purple tongue,the tongue coating is mainly composed of thin white coating,and the pulse pattern is mainly composed of taut pulse.3.The syndrome types are mainly phlegm and blood stasis syndrome,liver and kidney deficiency syndrome,yin deficiency and yang hyperactivity syndrome,and liver fire inflammation syndrome.4.The most commonly used traditional Chinese medicine decoction is the syndrome of phlegm and blood stasis:Banxia Baizhu Tianma Decoction combined with Tongqiao Huoxue Decoction;Liuwei Dihuang Pill in Liver and Kidney Deficiency Syndrome;Syndrome of Yin Deficiency and Yang Hyperactivity:Gastrodia elata and Gouteng Decoction;Syndrome of hyperactivity of liver fire:Tiaogan Jiangya Decoction.5.The commonly used traditional Chinese medicines are Angelica sinensis,Jujube,ginger,Poria cocos,Gastrodia elata,Atractylodes macrocephala,Eucommia ulmoides,Glycyrrhiza uralensis,Peony bark,Red peony root,bergamot,yam,peach kernel,etc.6.Cluster analysis was conducted on drugs with a frequency of medication greater than 20 times to obtain 6 commonly used drug pairs and 7 commonly used combinations.