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Account for Clinical Heterogeneity in Assessment of Catheter-based Renal Denervation among Resistant Hypertension Patients： Subgroup Meta-analysis

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Chinese Medical Journal 2017年第13期130卷 1586-1594页

作者： Xiao-Han Chen Sehee Kim Xiao-Xi Zeng Zhi-Bing Chen Tian-Lei Cui Zhang-Xue HU Yi Li Ping Fu Department of Nephrology Kidney Research Institute West China Hospital Sichuan University Chengdu Sichuan 610041 China Department of Biostatistics University of Michigan School of Public Health Ann Arbor Michigan 48109 USA West China Biostatistics and Cost-benefit Analysis Center of Sichuan University Chengdu Sichuan 610041 China Department of Burn and Plastic Surgery Chengdu Second People's Hospital Chengdu Sichuan 610017 China Kidney Epidemiology and Cost Center University of Michigan Ann Arbor Michigan 48109 USA

Background： Catheter-based renal denervation （RDN） is a novel treatment tbr resistant hypertension （RH）. A recent meta-analysis reported that RDN did not significantly reduce blood pressure （BP） based on the pooled effects with mild to severe heterogeneity. The aim of the present study was to identify and reduce clinical sources of heterogeneity and reassess the safety and efficacy of RDN within the identified homogeneous subpopulations. Methods： This was a meta-analysis of 9 randomized clinical trials （RCTs） among patients with RH up to June 2016. Sensitivity analyses and subgroup analyses were extensively conducted by baseline systolic blood pressure （SBP） level, antihypertensive medication change rates, and coronary heart disease （CHD）. Results： In all patients with RH, no statistical differences were found in mortality, severe cardiovascular events rate, and changes in 24-11 SBP and office SBP at 6 and 12 months. However, subgroup analyses showed significant differences between the RDN and control groups. In the subpopulations with baseline 24-h SBP 〉 155 mmHg （ 1 mmHg = 0.133 kPa） and the infrequently changed medication, the use of RDN resulted in a significant reduction in 24-h SBP level at 6 months （P = 0.100 and P = 0.009, respectively）. Subgrouping RCTs with a higher prevalent CHD in control showed that the control treatment was significantly better than RDN in office SBP reduction at 6 months （P 〈 0.001 ）. Conclusions： In all patients with RH, the catheter-based RDN is not more effective in lowering ambulatory or office BP than an optimized antihypertensive drug treatment at 6 and 12 months. However, among RH patients with higher baseline SBP, RDN might be more effective in reducing SBR

关键词： antihypertensive treatment Hypertension Randomized Controlled Trials Renal Denervation Subgroup Meta-analysis

Blood Pressure Targets in the Hypertensive Elderly

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Chinese Medical Journal 2017年第16期130卷 1968-1972页

作者： Peng Liu Jin-Gang Zheng Department of Cardiology China-Japan Friendship Hospital Beijing 100029 China

Objective： Hypertension is an important risk factor of cardiovascular disease and increases mortality in the elderly. However, the available medical evidences are both inconsistent and insufficient regarding establishing credible and useful blood pressure （BP） targets in the hypertensive elderly. This review summarizes the existing evidences used for establishing optimal BP targets for this patient population and points out some data inconsistencies which have added to the uncertainty. Data Sources： We conducted a search for the articles published in English in the PubMed database up to March 2017, with the keywords ＂hypertension,＂＂elderly,＂＂blood pressure,＂ and ＂antihypertensive.＂ Study Selection： Articles that related to BP targeting in the hypertensive elderly were selected for this review. Results： The selected studies indicated that antihypertensive therapy can substantially reduce the risk of cardiovascular events and mortality, for a subset of the elderly （60 years or older） with systolic BP 〉 160 mmHg. Studies regarding more strict targets yielded mixed findings. For the very old and frail patients （80 years or older）, there is a lack of evidence that optimal BP targets and intensive antihypertensives are helpful but in fact may be harmful. Conclusions： There are solid evidences that patients who are 60-80 years old and in good health have benefited from lowering their BP to below 150/90 mmHg. If well tolerated, the BP target can be further lowered to below 140/90 mmHg. However, for the very old and frail, individualized and careful assessment is crucial. antihypertensive treatment should be cautious and the adverse effect of drugs requires close monitoring as such treatment can be counterproductive.

关键词： antihypertensive treatment Blood Pressure Elderly Patients Hypertension

Comparison of Clinic and Ambulatory Blood Pressure in Response to antihypertensive Drugs in Chinese Patients

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Biomedical and Environmental Sciences 2007年第4期20卷 279-283页

作者： XIAO-RU CHENG YANG WANG BO HU XUAN JIA WEI LI National Center for Cardiovascular Diseases Cardiovascular Institute ＆ Fuwai Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100037 China

To compare the difference between 24-h ambulatory blood pressure （ABP） and trough clinic blood pressure （CBP） after 8 weeks of therapy. Methods The study used meta-regression analysis to summarize three randomized, double-blind, active controlled trials in order to compare the difference between the magnitude of the reduction in 24-h average ABP and CBP Patients. Chinese patients with seated diastolic blood pressure （SDBP） 95-115 mmHg and ambulatory diastolic blood pressure （ADBP）≥85 mmHg. Results The average age of 126 patients was 47.7 ＋ 8.3 years, ranging from 25 to 67 （95 males and 31 females）. All regimens reduced 24-h ABP and CBP after 8 weeks of treatment. In the 126 patients the baseline 24-h SBP and DBP values （142.7/94.4 mmHg） were markedly lower than those for clinic values （152.6/102.6 mmHg; P〈0.0001）. Similarly, the 24-h SBP and DBP values （132.7/87.7 mmHg） in week 8 were markedly lower than the clinic values （138.9/92.7 mmHg; P〈0.0001）. The differences between the treatment-induced reductions in 24-h ABP and CBP were statistically significant （the difference was 3.7/3.3 mmHg for SBP/DBP, P=***69/P〈O.O001）. Conclusion All regimens significantly reduced seated CBP and ABP. The effect of antihypertensive treatment was greater on CBP than that on ABP, suggesting that assessment on effectiveness of an antihypertensive treatment using CBP readings only has to be carefully interpreted, and a more systematic application of ABP monitoring should be adopted.

关键词： Ambulatory blood pressure antihypertensive treatment Clinic blood pressure Essential Hypertension