Higher compared to lower protein diets: beneficial effects on systolic blood pressure, total cholesterol and triacylglycerol concentrations: a systematic review and meta-analysis of randomised controlled trials

IntroductionConflicting results from multiple randomised trials indicate that the methods and effects of blood pressure (BP) reduction after acute intracerebral haemorrhage (ICH) are complex. The Blood pressure in Acute Stroke Collaboration is an international collaboration, which aims to determine the optimal management of BP after acute stroke including ICH.Methods and analysisA systematic review will be undertaken according to the Preferred Reporting Items for Systematic review and Meta-Analysis of Individual Participant Data (IPD) guideline. A search of Cochrane Central Register of Controlled Trials, EMBASE and MEDLINE from inception will be conducted to identify randomised controlled trials of BP management in adults with acute spontaneous (non-traumatic) ICH enrolled within the first 7 days of symptom onset. Authors of studies that meet the inclusion criteria will be invited to share their IPD. The primary outcome will be functional outcome according to the modified Rankin Scale. Safety outcomes will be early neurological deterioration, symptomatic hypotension and serious adverse events. Secondary outcomes will include death and neuroradiological and haemodynamic variables. Meta-analyses of pooled IPD using the intention-to-treat dataset of included trials, including subgroup analyses to assess modification of the effects of BP lowering by time to treatment, treatment strategy and patient’s demographic, clinical and prestroke neuroradiological characteristics.Ethics and disseminationNo new patient data will be collected nor is there any deviation from the original purposes of each study where ethical approvals were granted; therefore, further ethical approval is not required. Results will be reported in international peer-reviewed journals.PROSPERO registration numberCRD42019141136.

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Interventions for increasing adherence to blood pressure lowering medication: systematic review and meta-analysis of randomised controlled trials (RCTs)

BMC News and views ◽

10.1186/2048-4623-1-s3-pb058 ◽

2001 ◽

Vol 1 (S3) ◽

Author(s):

Knut Schroeder ◽

Tom Fahey ◽

Shah Ebrahim

Keyword(s):

Systematic Review ◽

Blood Pressure ◽

Randomised Controlled Trials ◽

Meta Analysis ◽

Controlled Trials ◽

Blood Pressure Lowering ◽

Pressure Lowering ◽

Randomised Controlled

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Effect of lowering blood pressure on cardiovascular events and mortality in patients on dialysis: a systematic review and meta-analysis of randomised controlled trials

Yearbook of Cardiology ◽

10.1016/s0145-4145(10)79925-1 ◽

2010 ◽

Vol 2010 ◽

pp. 10-12

Author(s):

W.J. Elliott

Keyword(s):

Systematic Review ◽

Blood Pressure ◽

Cardiovascular Events ◽

Randomised Controlled Trials ◽

Meta Analysis ◽

Controlled Trials ◽

Randomised Controlled

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Effects of iron intake on neurobehavioural outcomes in African children: a systematic review and meta-analysis of randomised controlled trials

Wellcome Open Research ◽

10.12688/wellcomeopenres.16931.1 ◽

2021 ◽

Vol 6 ◽

pp. 181

Author(s):

Agnes M. Mutua ◽

Kelvinson Mwangi ◽

Amina Abubakar ◽

Sarah H. Atkinson

Keyword(s):

Systematic Review ◽

Iron Deficiency ◽

Randomised Controlled Trials ◽

Iron Supplementation ◽

Meta Analysis ◽

Controlled Trials ◽

African Countries ◽

Beneficial Effects ◽

African Children ◽

Randomised Controlled

Background: Iron deficiency and developmental delay are common in African children. While experimental studies indicate an important role of iron in brain development, effects of iron on child development remain unclear. We aimed to evaluate the effects of iron supplementation or fortification on neurobehavioural outcomes in African children and further summarise these effects in children living in non-African countries for comparison. Methods: We searched PubMed, EMBASE, PsycINFO, Scopus and Cochrane Library for studies published up to 9th March 2021. We included randomised controlled trials (RCTs) evaluating effects of iron supplementation or fortification on neurobehavioural outcomes in children. Due to heterogeneity in study methods, we analysed the studies qualitatively and only seven RCTs with 11 arms were meta-analysed. Results: We identified 2155 studies and included 34 studies (n=9808) in the systematic review. Only five studies (n=1294) included African children while 29 (n=8514) included children living in non-African countries. Of the five African studies, two (n=647) reported beneficial effects of iron supplementation on neurobehavioural outcomes in anaemic children while three (n=647) found no beneficial effects. Of 29 studies in children living in non-African countries, nine (n=2925) reported beneficial effects of iron supplementation or fortification on neurobehavioural outcomes, seven (n=786) reported beneficial effects only in children who had iron deficiency, iron deficiency anaemia or anaemia while 13 (n=4803) reported no beneficial effects. Meta-analysis of seven studies (n=775) in non-African countries showed no beneficial effects of iron supplementation on cognitive or motor development in children. Conclusions: There are few studies in African children despite the high burden of iron deficiency and developmental delay in this population. Evidence on the effects of iron supplementation on neurobehavioural outcomes remains unclear and there is need for further well-powered studies evaluating these effects in African populations. PROSPERO registration: CRD42018091278 (20/03/2018)

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How does exercise treatment compare with antihypertensive medications? A network meta-analysis of 391 randomised controlled trials assessing exercise and medication effects on systolic blood pressure

British Journal of Sports Medicine ◽

10.1136/bjsports-2018-099921 ◽

2018 ◽

Vol 53 (14) ◽

pp. 859-869 ◽

Cited By ~ 62

Author(s):

Huseyin Naci ◽

Maximilian Salcher-Konrad ◽

Sofia Dias ◽

Manuel R Blum ◽

Samali Anova Sahoo ◽

...

Keyword(s):

Blood Pressure ◽

Resistance Exercise ◽

Systolic Blood Pressure ◽

Randomised Controlled Trials ◽

Meta Analysis ◽

Controlled Trials ◽

Dynamic Resistance ◽

Antihypertensive Medications ◽

Exercise Interventions ◽

Randomised Controlled

ObjectiveTo compare the effect of exercise regimens and medications on systolic blood pressure (SBP).Data sourcesMedline (via PubMed) and the Cochrane Library.Eligibility criteriaRandomised controlled trials (RCTs) of angiotensin-converting enzyme inhibitors (ACE-I), angiotensin-2 receptor blockers (ARBs), β-blockers, calcium channel blockers (CCBs) and diuretics were identified from existing Cochrane reviews. A previously published meta-analysis of exercise interventions was updated to identify recent RCTs that tested the SBP-lowering effects of endurance, dynamic resistance, isometric resistance, and combined endurance and resistance exercise interventions (up to September 2018).DesignRandom-effects network meta-analysis.OutcomeDifference in mean change from baseline SBP between comparator treatments (change from baseline in one group minus that in the other group) and its 95% credible interval (95% CrI), measured in mmHg.ResultsWe included a total of 391 RCTs, 197 of which evaluated exercise interventions (10 461 participants) and 194 evaluated antihypertensive medications (29 281 participants). No RCTs compared directly exercise against medications. While all medication trials included hypertensive populations, only 56 exercise trials included hypertensive participants (≥140 mmHg), corresponding to 3508 individuals. In a 10% random sample, risk of bias was higher in exercise RCTs, primarily due to lack of blinding and incomplete outcome data. In analyses that combined all populations, antihypertensive medications achieved higher reductions in baseline SBP compared with exercise interventions (mean difference −3.96 mmHg, 95% CrI −5.02 to −2.91). Compared with control, all types of exercise (including combination of endurance and resistance) and all classes of antihypertensive medications were effective in lowering baseline SBP. Among hypertensive populations, there were no detectable differences in the SBP-lowering effects of ACE-I, ARB, β-blocker and diuretic medications when compared with endurance or dynamic resistance exercise. There was no detectable inconsistency between direct and indirect comparisons. Although there was evidence of small-study effects, this affected both medication and exercise trials.ConclusionsThe effect of exercise interventions on SBP remains under-studied, especially among hypertensive populations. Our findings confirm modest but consistent reductions in SBP in many studied exercise interventions across all populations but individuals receiving medications generally achieved greater reductions than those following structured exercise regimens. Assuming equally reliable estimates, the SBP-lowering effect of exercise among hypertensive populations appears similar to that of commonly used antihypertensive medications. Generalisability of these findings to real-world clinical settings should be further evaluated.

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