Chinese Herbal Medicine Reduces the Risk of Heart Failure in Hypertensive Patients: A Nationwide, Retrospective, Cohort Study

Abstract

BackgroundHypertension (HTN) is the leading preventable risk factor for cardiovascular disease worldwide. Patients with HTN are at higher risk for heart failure (HF). The currently available therapeutic approaches for HTN do not always optimally control blood pressure or are not suitable for hypertensive patients who have a higher number of comorbidities. This study aimed to determine whether Chinese herbal medicine (CMH)-based interventions could reduce the risk of HF in hypertensive patients.MethodsThis retrospective study randomly selected 2 million enrollees from the National Health Insurance Research Database and identified 507,608 patients who were newly diagnosed with HTN in 2000–2017. After 1:1 frequency-matching by age, sex, index year, income, urbanization, duration of HTN, comorbidities and antihypertensive medications, we selected 8,912 eligible patients in each group. During 16 years of follow-up, 380 CHM users and 426 CHM non-users developed HF, representing incidence rates of 6.29 and 7.43 per 1,000 person-years, respectively.ResultsCHM users had significantly lower HF risk compared with CHM non-users (adjusted HR = 0.85, 95% CI 0.74–0.98). The markedly predominant effect was observed in those receiving CHM products for more than 180 days (adjusted HR = 0.65). The frequently prescribed formula, Jia-Wei-Xiao-Yao-San, and the single herbs Ge Gen, Huang Qi, Du Zhong, Huang Qin, and Chuan Xiong were significantly associated with lower risk of HF.ConclusionsThis population-based study revealed decreased HF risk in hypertensive patients with CHM use. These findings may provide a reference for HF prevention strategies and support the integration of CHM into clinical intervention programs that provide a favorable prognosis for hypertensive patients.

Current Research Status and Implication for Further Study of Real-World Data on East Asian Traditional Medicine for Heart Failure: A Scoping Review

“…Of the 258 studies identified, 12 were selected ( Figure 1 ), of which 8 were conducted in patients with HF [ 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ]. Of the remaining four studies, HF occurrence was the primary outcome in two [ 31 , 32 ] and secondary outcome in the other two studies [ 33 , 34 ]. Among the eight studies involving patients with HF, four included patients with CHF [ 23 , 24 , 26 , 28 ], one included patients with acute HF [ 25 ], and one included patients with acute decompensated HF [ 27 ].…”

“…Two studies included unspecified patients with HF [ 29 , 30 ]. Geographically, the studies were distributed as follows: six in China [ 24 , 26 , 27 , 28 , 33 , 34 ], five in Taiwan [ 23 , 29 , 30 , 31 , 32 ], and one in Japan [ 25 ]. The National Health Insurance Research Database was used in Taiwan, whereas in the other two countries, EMR data from hospitals was used ( Table 1 ).…”

“…Regarding methodological and statistical analyses, five studies conducted survival analysis using propensity score matching [ 23 , 24 , 29 , 31 , 32 ]; some included a dose–response analysis to explore causality [ 23 ]. Independent t -tests or chi-square tests (which did not consider the time-to-event analysis) were used to compare the mean or ratio of clinical indicators [ 27 , 28 , 29 , 33 , 34 ].…”

“…Logistic regression analysis was used to identify the factors influencing the occurrence of cardiac events [ 24 , 25 , 33 , 34 ]. Regression analysis was also conducted to predict the factors influencing the use of traditional Chinese medicine [ 27 , 30 , 32 , 33 , 34 ]. One study performed multivariate logistic regression analyses and presented nomograms, receiver operating characteristic curves, and clinical decision curve analyses to construct a model for predicting survival [ 26 ].…”

“…Among individuals undergoing doxorubicin chemotherapy for breast cancer, TCM use was associated with a lower incidence of CHF [ 31 ]. Another study found a lower incidence of HF when botanical drugs were used for over 180 days in patients with hypertension [ 32 ]. Among patients with MI, the TCM group had a lower incidence of acute HF [ 33 , 34 ].…”