2-8THE EFFECT OF LACTOBACILLUS CONSUMPTION ON SYSTOLIC AND DIASTOLIC BLOOD PRESSURE: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

Abstract Introduction Nocturnal blood pressure (BP) and early morning BP surge have consistently been found to be a better prognostic marker of cardiovascular outcome than daytime BP. Most anti-hypertensive show greater blood pressure-lowering effect in the first 12 hours compared to the next 12 hours. Several prospective studies have shown better BP regulation and improved cardiovascular risk when anti-hypertensive are ingested at bedtime versus at awakening. Purpose In patients with hypertension does evening dosing of anti-hypertensive compared to morning dosing led to better reduction in pressure, blood pressure control and reduced cardiovascular morbidity. Methods A meta-analysis was performed based on randomized controlled trials obtained from Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, Medline and Medline ahead of print published between 2000 and 2020. Main outcome measures include mean 24 hour systolic and diastolic blood pressure, cardiovascular events as well as prevalence of blood pressure in control. Data synthesis and analysis was done using RevMan 5.3 using a random effects model. Results A total of 40 randomized controlled trials, representing 44,167 patients were included in this meta-analysis. Most studies evaluate the administration of mixed anti-hypertensive with ≥1 medication ingested at bedtime, calcium channel blockers (CCBs) or angiotensin receptor blockers (ARBs) with sample sizes ranging from 30 to 19,084 patients. Evening administration of anti-hypertensive was found to significantly lower 24-hour systolic blood pressure (Mean difference = −1.05, 95% CI: −2.01 to −0.10, p=0.03) and 24-hour diastolic blood pressure (Mean difference = −1.09, 95% CI: −1.68 to −0.50, p=0.0003). Prevalence of controlled blood pressure was found to significantly increase with evening dosing (RR=1.15, 95% CI: 1.03 to 1.28, p=0.01). Significant reduction in cardiovascular events were found in the evening dosing group (RR=0.48, 95% CI: 0.03 to 0.68, p=<0.00001). Discussion Reduction in night-time blood pressure especially among non-dippers as reported in previous studies and higher prevalence of controlled blood pressure may explain the greater than 50% reduction in cardiovascular events in the evening dosing group. This marked benefit from a simple and inexpensive strategy certainly has great potential to benefit patients in practice. Even so, few studies have reported the prevalence of blood pressure in control (9 studies) and cardiovascular events (6 studies). Few has also studied this in geriatric populations where night-time hypotension and hypoperfusion may bring the most impact. Conclusion For patients with hypertension, evening dosing significantly improves blood pressure control and reduces the risk for cardiovascular events. Careful selection of anti-hypertensive administration time in patients is recommended given the possible benefits. Anti Hypertensive Dosing Forest Plot Funding Acknowledgement Type of funding source: None

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The Antihypertensive Effects and Safety of LCZ696 in Patients with Hypertension: A Systemic Review and Meta-Analysis of Randomized Controlled Trials

Journal of Clinical Medicine ◽

10.3390/jcm10132824 ◽

2021 ◽

Vol 10 (13) ◽

pp. 2824

Author(s):

Su-Kiat Chua ◽

Wei-Ting Lai ◽

Lung-Ching Chen ◽

Huei-Fong Hung

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Randomized Controlled Trials ◽

Diastolic Blood Pressure ◽

Publication Bias ◽

Meta Analysis ◽

Systemic Review ◽

Controlled Trials ◽

Randomized Controlled ◽

The Mean

Background: The management of hypertension remains suboptimal throughout the world. Methods: We performed a random-effects model meta-analysis of randomized controlled trials to determine the effectiveness and safety of sacubitril/valsartan (LCZ696) for the treatment of high arterial pressure. Relevant published articles from PubMed, Cochrane base, and Medline were examined, and the last search date was December 2020. Only published randomized controlled trials and double-blind studies were selected for further analysis. The mean reductions in systolic blood pressure (msSBP) and diastolic blood pressure (msDBP) in the sitting position, as well as the mean reductions in ambulatory systolic blood pressure (maSBP) and ambulatory diastolic blood pressure (maDBP), were assumed as efficacy endpoints. Adverse events (AEs) were considered as safety outcomes. Results: Ten studies with a total of 5931patients were included for analysis. Compared with placebo, LCZ696 had a significant reduction in msSBP (weight mean difference (WMD) = −6.52 mmHg, 95% confidence interval (CI): −8.57 to −4.47; p < 0.001), msDBP (WMD = −3.32 mmHg, 95% CI: −4.57 to −2.07; p < 0.001), maSBP (WMD = −7.08 mmHg, 95% CI: −10.48 to −3.68; p < 0.001), maDBP (WMD = −3.28 mmHg, 95% CI: −4.55 to −2.02, p < 0.001). In subgroup analysis, only 200 mg and 400 mg LCZ696 showed a significant BP reduction. There was no difference in the AE rate between the LCZ696 and placebo groups (WMD = 1.02, 95% CI: 0.83 to 1.27, p = 0.54). Egger’s test revealed a potential publication bias for msSBP (p = 0.025), but no publication bias for other outcomes. Conclusion: LCZ696 may reduce blood pressure more efficaciously than traditional therapy in hypertensive patients without increasing adverse effects.

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The effect of glucagon-like peptide-1 receptor agonists on 24-hour ambulatory blood pressure: a meta-analysis

European Heart Journal ◽

10.1093/eurheartj/ehab724.2950 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

D Patoulias ◽

A Boulmpou ◽

C E Papadopoulos ◽

F Siskos ◽

K Stavropoulos ◽

...

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Randomized Controlled Trials ◽

Diastolic Blood Pressure ◽

Ambulatory Blood Pressure ◽

Meta Analysis ◽

Controlled Trials ◽

Randomized Controlled ◽

Glucagon Like Peptide ◽

Glucagon Like Peptide 1

Abstract Background Hypertension augments overall cardiovascular risk in patients with type 2 diabetes mellitus (T2DM), constituting a major additional burden for diabetic subjects; however, control rates of hypertension remain suboptimal. Glucagon-like peptide-1 receptor agonists (GLP-1RAs), second-line treatment option for diabetics, have revolutionized the field of T2DM therapeutic management due to their pleiotropic effects, while they seem to hold multiple cardiovascular benefits. A few randomized controlled trials (RCTs) evaluated the effect of GLP-1RAs on ambulatory blood pressure (ABP). Ambulatory blood pressure monitoring (ABPM) provides a better method to predict long-term cardiovascular outcomes than office blood pressure. Purpose We sought to determine the effect of GLP-1RAs on ABPM, pooling data from relevant randomized controlled trials (RCTs). Methods We searched 2 major electronic databases, namely PubMed and Cochrane/CENTRAL, along with grey literature sources, for RCTs assessing the effect of various GLP-1RAs on ABP in patients with T2DM. Results After screening of the potentially eligible records, 7 RCTs were finally included in our meta-analysis (4 parallel-group and 3 cross-over). GLP-1RA treatment compared to placebo or active control resulted in a nonsignificant decrease in 24-h systolic blood pressure (MD=−1.57 mm Hg, 95% CI: −4.12 to 0.98, I2=63%) (Figure 1) and in 24-h diastolic blood pressure (MD=1.28 mmHg, 95% CI: −0.31 to 2.87, I2=49%) (Figure 2). No subgroup differences between the various GLP-1RAs were identified. More specifically, it was demonstrated that liraglutide once daily produced a non-significant decrease in 24-h systolic blood pressure (MD=−1.43 mm Hg, 95% CI: −5.24 to 2.38, I2=72%) and a non-significant increase in 24-h diastolic blood pressure (MD=1.47 mm Hg, 95% CI: −1.12 to 4.05, I2=61%), while data concerning the effect of once weekly dulaglutide and twice daily exenatide on ABPM were pooled from one RCT respectively (Figures 1, 2). Conclusions Antidiabetic treatment with GLP-1RAs does not influence either systolic or diastolic ABP in patients with T2DM. FUNDunding Acknowledgement Type of funding sources: None. Figure 1 Figure 2

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Exercise and Resting Blood Pressure in Children and Adolescents: A Meta-Analysis

Pediatric Exercise Science ◽

10.1123/pes.15.1.83 ◽

2003 ◽

Vol 15 (1) ◽

pp. 83-97 ◽

Cited By ~ 9

Author(s):

George A. Kelley ◽

Kristi S. Kelley

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Randomized Controlled Trials ◽

Children And Adolescents ◽

Diastolic Blood Pressure ◽

Meta Analysis ◽

Controlled Trials ◽

Randomized Controlled ◽

Resting Blood Pressure ◽

Initial Blood Pressure

The purpose of this study was to use the meta-analytic approach to examine the effects of exercise on resting systolic and diastolic blood pressure in children and adolescents. Twenty-five studies that included 84 groups (45 exercise, 39 control) and 3,189 subjects (1,885 exercise, 1,304 control) met the criteria for inclusion. Using a random effects model, non-significant decreases of approximately 2% were found for resting systolic (mean – SEM, –2 – 1 mmHg, 95% CI, –4 to 1 mmHg) and diastolic (mean – SEM, –1 – 1 mmHg, 95% CI, –3 to 1 mmHg) blood pressure. Greater decreases in resting systolic blood pressure were found for nonrandomized versus randomized controlled trials (p = 0.001). There was also a statistically significant association between changes in resting systolic blood pressure and initial blood pressure (r = 0.73, p < 0.001) and body weight (r = 0.64, p < 0.001). However, when limited to randomized trials, these results were no longer statistically significant. The results of this study suggest that exercise does not reduce resting systolic and diastolic blood pressure in children and adolescents. However, a need exists for additional randomized controlled trials, especially among hypertensive children and adolescents.

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The effect of regular aquatic exercise on blood pressure: A meta-analysis of randomized controlled trials

European Journal of Preventive Cardiology ◽

10.1177/2047487317731164 ◽

2017 ◽

Vol 25 (2) ◽

pp. 190-199 ◽

Cited By ~ 20

Author(s):

Yutaka Igarashi ◽

Yoshie Nogami

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Randomized Controlled Trials ◽

Diastolic Blood Pressure ◽

Endurance Exercise ◽

Meta Analysis ◽

Aquatic Exercise ◽

Control Group ◽

Controlled Trials ◽

Randomized Controlled

Background No meta-analysis has examined the effect of regular aquatic exercise on blood pressure. The purpose of this study was to perform a meta-analysis to evaluate the effects of regular aquatic exercise on blood pressure. Design A meta-analysis of randomized controlled trials. Methods Databases were searched for literature published up to April 2017. The randomized controlled trials analysed involved healthy adults, an intervention group that only performed aquatic exercise and a control group that did not exercise, no other intervention, and trials indicated mean systolic blood pressure or diastolic blood pressure. The net change in blood pressure was calculated from each trial, and the changes in blood pressure were pooled by a random effects model, and the risk of heterogeneity was evaluated. Subgroup analysis of subjects with hypertension, subjects who performed endurance exercise (or not), and subjects who only swam (or not) was performed, and the net changes in blood pressure were pooled. Results The meta-analysis examined 14 trials involving 452 subjects. Pooled net changes in blood pressure improved significantly (systolic blood pressure −8.4 mmHg; diastolic blood pressure −3.3 mmHg) and the changes in systolic blood pressure contained significant heterogeneity. When subjects were limited to those with hypertension, those who performed endurance exercise and subjects who did not swim, pooled net changes in systolic and diastolic blood pressure decreased significantly, but the heterogeneity of systolic blood pressure did not improve. Conclusion Like exercise on land, aquatic exercise should have a beneficial effect by lowering blood pressure. In addition, aquatic exercise should lower the blood pressure of subjects with hypertension, and other forms of aquatic exercise besides swimming should also lower blood pressure.

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Effects of the Small-Sided Soccer Games on Blood Pressure in Untrained Hypertensive Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Healthcare ◽

10.3390/healthcare9030345 ◽

2021 ◽

Vol 9 (3) ◽

pp. 345

Author(s):

Filipe Manuel Clemente ◽

Rodrigo Ramirez-Campillo ◽

Hugo Sarmento

Keyword(s):

Systematic Review ◽

Blood Pressure ◽

Randomized Controlled Trials ◽

Diastolic Blood Pressure ◽

Meta Analysis ◽

Intervention Group ◽

Control Group ◽

Controlled Trials ◽

Control Groups ◽

Randomized Controlled

This systematic review with meta-analysis was conducted to assess the effects of small-sided games (SSGs)-based programs on the systolic and diastolic blood pressure of untrained hypertensive adults. The data sources utilized were Web of Science, Scopus, SPORTDiscus, and PubMed. The eligibility criteria were: (i) randomized controlled trials including a control group and an intervention group exclusively using soccer SSGs; (ii) intervention and control groups including an untrained hypertensive adult population; (iii) articles written in English; and (iv) only full-text and original articles. The database search initially identified 241 titles. From those, five articles were eligible for the systematic review and meta-analysis. The included randomized controlled studies involved five individual experimental groups and 88 participants, and 68 participants in the five control groups. The results showed a large and beneficial effect of SSG on systolic (ES = 1.69; 95% CI = 0.71 to 2.66; p = 0.001; I2 = 85.2%; Egger’s test p = 0.101) and diastolic blood pressure (ES = 2.25; 95% CI = 1.44 to 3.06; p < 0.001; I2 = 74.8%; Egger’s test p = 0.118) when compared to the control groups. The findings of the current systematic review and meta-analysis revealed consistent beneficial effects of recreational soccer SSGs on untrained men and women from the hypertensive population, although high levels of heterogeneity.

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Isometric exercise and inter-individual response differences on resting systolic and diastolic blood pressure in adults: a meta-analysis of randomized controlled trials

Blood Pressure ◽

10.1080/08037051.2021.1940837 ◽

2021 ◽

pp. 1-12

Author(s):

George A. Kelley ◽

Kristi S. Kelley ◽

Brian L. Stauffer

Keyword(s):

Blood Pressure ◽

Randomized Controlled Trials ◽

Diastolic Blood Pressure ◽

Meta Analysis ◽

Isometric Exercise ◽

Controlled Trials ◽

Individual Response ◽

Randomized Controlled

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Vitamin D ameliorates systolic but not diastolic blood pressure in patients with type 2 diabetes: Results from a meta-analysis of randomized controlled trials

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831/a000291 ◽

2018 ◽

Vol 88 (1-2) ◽

pp. 90-99 ◽

Cited By ~ 1

Author(s):

Tina Jafari ◽

Aziz A. Fallah ◽

Noushin Rostampour ◽

Leila Mahmoodnia

Keyword(s):

Blood Pressure ◽

Type 2 Diabetes ◽

Vitamin D ◽

Randomized Controlled Trials ◽

Diastolic Blood Pressure ◽

Meta Analysis ◽

Controlled Trials ◽

Randomized Controlled ◽

Type 2 Diabetic

Abstract. Inconsistent findings have been reported regarding the effects of vitamin D on blood pressure in patients with type 2 diabetes (T2D). This study aimed to evaluate the subject through a meta-analysis. A computerized literature search on five databases was performed and randomized controlled trials (RCTs) published until March 2016 were identified. The eligibility criteria for articles to be selected were parallel-group RCTs in which consumption of a kind of vitamin D was compared with placebo in patients with T2D. Un-standardized mean difference and its corresponding 95 % confidence interval (CI) was calculated from the effect sizes by using random effects model. Studies comparing intervention group (received vitamin D) with control group (received placebo) were enrolled in meta-analysis. Meta-analysis on 26 studies with 1789 type 2 diabetic subjects showed that vitamin D significantly reduced systolic blood pressure (SBP; –0.97 mmHg, 95 % CI: –1.94, –0.001, P = 0.050), but not diastolic blood pressure (DBP; –0.10 mmHg, 95 % CI: –0.22, 0.02, P = 0.087). Subgroup analyses showed that administration of vitamin D in patients with baseline serum 25-hydroxy vitamin D < 50 nmol/l and baseline SBP < 140 mmHg significantly reduced SBP. Moreover, the patients who received vitamin D without Ca co-supplementation showed significant reduction in SBP. Vitamin D doses (≤ 2000 or > 2000 IU/day) and method of vitamin D application (Supplementation or food fortification) did not affect the blood pressure. This study demonstrated that vitamin D improved SBP in type 2 diabetic patients. Therefore, this vitamin can be considered as an adjuvant therapy in these patients.

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Melatonin for Atypical Antipsychotic-Induced Metabolic Adverse Effects: A Meta-Analysis of Randomized Controlled Trials

BioMed Research International ◽

10.1155/2018/4907264 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8 ◽

Cited By ~ 4

Author(s):

Ashwin Kamath ◽

Zahoor Ahmad Rather

Keyword(s):

Blood Pressure ◽

Adverse Effects ◽

Randomized Controlled Trials ◽

Diastolic Blood Pressure ◽

Atypical Antipsychotic ◽

Meta Analysis ◽

Mean Difference ◽

Cochrane Library ◽

Controlled Trials ◽

Randomized Controlled

The objective of our study was to determine the effect of melatonin administration on atypical antipsychotic-induced metabolic adverse effects in patients with psychiatric disorders. A systematic search was performed in PUBMED, Cochrane Library, Scopus, Web of Science, and EBSCOhost electronic databases. Randomized controlled trials studying the effect of melatonin on antipsychotic-induced metabolic adverse effects were identified and subjected to meta-analysis. Four studies were included in the meta-analysis, including 57 patients on melatonin and 61 patients on placebo. Melatonin produced a significant decrease in the diastolic blood pressure compared with placebo (mean difference = −4.44 [95% CI, −7.00 to −1.88]; p=0.0007; I2 = 13%), but not the systolic blood pressure (mean difference = −4.23 [95% CI, −8.11 to −0.36]; p=0.03; I2 = 0%). Although a decrease in the body mass index was seen in the melatonin group, the difference was not significant in the random-effects analysis model. To conclude, in patients on atypical antipsychotics, melatonin at a dose of up to 5 mg/day for a treatment duration of up to 12 weeks attenuated the rise in diastolic blood pressure compared with placebo but had no significant effects on other metabolic parameters.

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Effect of Spirulina Supplementation on Systolic and Diastolic Blood Pressure: Systematic Review and Meta-Analysis of Randomized Controlled Trials

Nutrients ◽

10.3390/nu13093054 ◽

2021 ◽

Vol 13 (9) ◽

pp. 3054

Author(s):

Piotr Machowiec ◽

Gabriela Ręka ◽

Marcela Maksymowicz ◽

Halina Piecewicz-Szczęsna ◽

Agata Smoleń

Keyword(s):

Blood Pressure ◽

Confidence Interval ◽

Randomized Controlled Trials ◽

Diastolic Blood Pressure ◽

Meta Analysis ◽

Mean Difference ◽

Cochrane Library ◽

Controlled Trials ◽

Significant Lowering ◽

Randomized Controlled

Spirulina is a microalga that presents various important pro-health properties, for instance lowering blood pressure in the research. The study aims to appraise the efficacy of Spirulina administration on systolic (SBP) and diastolic blood pressure (DBP). Randomized controlled trials (RCTs) were retrieved by a systematic search of PubMed, Web of Science, and the Cochrane Library databases from inception to June 2021 according to a standardized protocol. The effect size of each study was counted from mean and standard deviation before and after the intervention and shown as Un-standardized mean difference and 95% confidence interval. Sensitivity analyses were performed. Meta-analysis on 5 RCTs with 230 subjects was eligible. The amount of Spirulina ranged from 1 to 8 g per day, and intervention durations ranged from 2 to 12 weeks. Data analysis indicated that Spirulina supplementation led to a significant lowering of SBP (Mean Difference (MD): −4.59 mmHg, 95% Confidence Interval (CI): −8.20 to −0.99, I square statistic (I2) = 65%) and significant lowering of DBP (MD: −7.02 mmHg, CI: −8.86 to −5.18, I2 = 11%), particularly in a subgroup of hypertensive patients. Spirulina administration might have a supportive effect on the prevention and treatment of hypertension. More exact randomized controlled trials are needed to clarify the effect of Spirulina supplementation on blood pressure.

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