The Effect of Chinese Herbal Medicine Combined With Western Medicine on Vascular Endothelial Function in Patients With Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

Objective: Vascular endothelium plays a fundamental role in regulating endothelial dysfunction, resulting in structural changes that may lead to adverse outcomes of hypertension. The aim of this study was to systematically evaluate the effect of a combination of Chinese herbal medicine (CHM) and Western medicine on vascular endothelial function in patients with hypertension.Methods: We systematically searched the literature for studies published in Chinese and English in PubMed, Embase, Cochrane Central Register of Controlled Trials, Chinese Biomedical Literature Database, China Knowledge Resource Integrated Database, Wanfang Data, and China Science and Technology Journal Database. Databases were searched using terms concerning or describing CHM, hypertension, vascular endothelium, and randomized controlled trials. RevMan 5.3.0 was used for data analysis. If the included studies were sufficiently homogeneous, quantitative synthesis was performed; if studies with different sample sizes and blind methods were used, subgroup analyses were performed. GRADEpro was selected to grade the current evidence to reduce bias in our findings.Results: In this review, 30 studies with 3,235 patients were enrolled. A relatively high selection and a performance bias were noted by risk of bias assessments. Meta-analysis showed that the combination of CHM and conventional Western medicine was more efficient than conventional Western medicine alone in lowering blood pressure (risk ratio, 1.21; 95% CI, 1.16 to 1.26) and increasing nitric oxide (95% CI, 1.24 to 2.08; P < 0.00001), endothelin-1 (95% CI, −1.71 to −1.14; P < 0.00001), and flow-mediated dilation (95% CI, 0.98 to 1.31; P <0.00001). No significant difference was observed between the combination of CHM and conventional Western medicine and conventional

Understanding Traditional Chinese Medicine Therapeutics: An Overview of the Basics and Clinical Applications

“…Three articles were excluded because one was a commentary, the other was a protocol, and the last used an animal model. The diversity of pathologies covered by the remaining articles is considerable, with three articles related to cancer (involving 54, 14 and 18 RCTs) [ 33 , 34 , 35 ], three related to hypertension (involving 30, 17 and 39 RCTs) [ 36 , 37 , 38 ], three related to COVID-19 (involving 19, 7 and 18 RCTs) [ 39 , 40 , 41 ], two related to depression (involving 40 and 16 RCTs) [ 42 , 43 ], two related to headache (involving 31 and 30 RCTs) [ 44 , 45 ], and the others related to allergic rhinitis (involving 17 RCTs) [ 46 ], spinal cord injury (involving 26 RCTs) [ 47 ], breast pain (involving 17 RCTs) [ 48 ], primary Raynaud’s phenomenon (involving 8 RCTs) [ 49 ], insomnia (involving 13 RCTs) [ 50 ], erectile dysfunction (involving 11 RCTs) [ 51 ], post-stroke spasticity (involving 35 RCTs) [ 52 ], irritable bowel syndrome with diarrhea (involving 21 RCTs) [ 53 ], diabetic kidney disease (involving 20 RCTs) [ 54 ], and Wilson’s disease (involving 18 RCTs) [ 55 ]. All articles reported the beneficial effects of Chinese herbal medicine when used as a primary treatment or adjunct therapy to Western medicine.…”

“…The diversity of pathologies covered by the remaining articles is considerable, with three articles related to cancer (involving 54, 14 and 18 RCTs)[33][34][35], three related to hypertension (involving 30, 17 and 39 RCTs)[36][37][38], three related to COVID-19 (involving 19, 7 and 18 RCTs)[39][40][41], two related to depression (involving 40 and 16 RCTs)[42,43], two related to headache (involving 31 and 30 RCTs)[44,45], and the others related to allergic rhinitis (involving 17 RCTs)[46], spinal cord injury (involving 26 RCTs)…”

Deciphering the Efficacy and Mechanisms of Chinese Herbal Medicine for Diabetic Kidney Disease by Integrating Web-Based Biochemical Databases and Real-World Clinical Data: Retrospective Cohort Study

“…Some studies have declared that simultaneous use of more than one drug is a good strategy for treating DKD patients because of different mechanisms [75][76][77]. However, whether CHM should be used with ACEis or ARBs remained unexplored, even though use of CHM with ACEis or ARBs simultaneously may improve blood pressure control among hypertension patients [78]. Our study reported the rationale of combining an ACEi or ARB with CHM for DKD patients by presenting the long-term benefits and the different coverage of DKD-related proteins and molecular pathways.…”

Deciphering the Efficacy and Mechanisms of Chinese Herbal Medicine for Diabetic Kidney Disease by Integrating Web-Based Biochemical Databases and Real-World Clinical Data: Retrospective Cohort Study (Preprint)

“…Some studies have declared that simultaneous use of more than one drug is a good strategy for treating DKD patients because of different mechanisms [75][76][77]. However, whether CHM should be used with ACEis or ARBs remained unexplored, even though use of CHM with ACEis or ARBs simultaneously may improve blood pressure control among hypertension patients [78]. Our study reported the rationale of combining an ACEi or ARB with CHM for DKD patients by presenting the long-term benefits and the different coverage of DKD-related proteins and molecular pathways.…”