Total Flavones of Hippophae Rhamnoides L. for Essential Hypertension: A Systematic Review of Randomized Controlled Trials_Chinese Journal of Evidence-Based Medicine

Authors：

1. Department of Geriatrics, West China Hospital, Sichuan University, Chengdu 610041, China2. Tibet Autonomous Region in Chengdu Office Hospital, Chengdu 610041, China3. The First People’s Hospital of Yibin, Yibin 644000, Sichuan Province, China;

Corresponding author：

Keywords：

Total flavones of Hippophae Rhamnoides L.; Essential hypertension; Randomized controlled trial; Systematic review; Meta-analysis

DOI：

10.7507/1672-2531.20090217

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Objective 　To assess the efficacy, safety, and economy of Total flavones of Hippophae Rhamnoides L. (TFH) for Essential Hypertension.
Methods 　We searched the Cochrane Central Register of Controlled Trials (Issue 2, 2009), MEDLINE (1950 to June 2009), EMbase (1980 to June 2009), CNKI (1995 to June 2009), and VIP (1989 to June 2009). We also handsearched the relevant journals and conference proceedings. Then we screened the retrieved studies according to predefined inclusion and exclusion criteria, evaluated the quality of the included studies, and performed meta-analyses using the Cochrane Collaboration RevMan 5.0 software.
Results 　Only seven trials involving 644 patients were included. The results of meta-analyses showed that TFH had the similar effects to calcium-channel blocker (CCB) (WMD 2.34, 95%CI –0.86 to 5.53) and angiotensin-converting enzyme inhibitor (ACEI) (WMD –0.01, 95%CI – 0.97 to 0.95) in decreasing diastolic blood pressure, but TFH plus CCB was superior to CCB in decreasing systolic blood pressure (P lt;0.000 01) and diastolic blood pressure (P lt;0.000 01). TFH was inferior to ACEI in improving left ventricular posterior wall thickness (LVPWT) (P lt;0.000 01) and inter ventricular septum thickness (IVST) (P lt;0.000 01), but TFH plus CCB was more effective in improving LVPWT (P lt;0.000 01) and IVST (P lt;0.000 01). Moreover, TFH was similar to ACEI in regulating blood β2-microglobulin (WMD –0.57, 95%CI –1.18 to 0.04), creatinine clearance rate (P=0.19), and urinary albumin value in 24 hours (P=0.42). The incidence of adverse effects was significantly lower in the TFH group compared to the ACEI group.
Conclusion 　The evidence available shows that TFH may decrease systolic and diastolic blood

Citation： CHANG Binbin,WANG Feng,XU Tingyuan,ZHANG Qingqiong,HE Jun,ZHANG Xinjun,LI Jun. Total Flavones of Hippophae Rhamnoides L. for Essential Hypertension: A Systematic Review of Randomized Controlled Trials. Chinese Journal of Evidence-Based Medicine, 2009, 09(11): 1207-1213. doi: 10.7507/1672-2531.20090217 Copy

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10.	黄良月. 醋柳黄酮防治冠心病药理基础研究. 华西药学杂志, 1986, 1(2): 163.
11.	曹子寿. 雅达心达康治疗冠心病心绞痛的疗效观察. 临床心血管杂志, 1995, 11(3): 190.
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13.	王美华, 朱福, 陆铭, 等. 醋柳黄酮对高血压病患者肾功能的影响. 中国全科学, 2002, 5(6): 447-448.
14.	徐武华, 陈坚, 邓哲彤. 醋柳黄酮与依那普利治疗高血压的临床对照研究. 中国综合临床, 2001, 1(12): 903-904.
15.	廖晓阳, 张茂顺, 王伟文, 等. 醋柳黄酮对原发性高血压患者一氧化氮, 内皮素的影响. 华西医学, 2005, 20(2): 247-248.
16.	龚铭, 廖晓阳, 章茂顺, 等. 醋柳黄酮对高血压游离钙及胰岛素敏感性的影响. 现代中西医结合杂志, 2000, 9(14): 1303.
17.	张新军, 章茂顺, 王家良, 等. 醋柳黄酮对高血压患者交感神经兴奋性的影响, 四川大学学报(医学版), 2001, 32(4): 547.
18.	韩清华, 张庚天, 尚美生. 醋柳黄酮对高血压病患者左心室肥厚的逆转作用. 中国中西医结合杂志, 2001, 21(3): 215.
19.	Mancia, Giuseppe, De Backer, et al. 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension（ESH) and of the European Society of Cardiology （ESC). Journal of Hypertension, 2007, 25(6): 1105-1187.
20.	Hansson L, Zanchetti A, Carruthers SG, et al. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment（HOT) randomized trial. Lancet, 1998, 351(9118): 1755-1762.
21.	Sever PS, Poulter NR, Wedel H, et al. revention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial--Lipid Lowering Arm （ASCOT-LLA): a multicentre randomized controlled trial. Lancet, 2003, 361(9364): 1149-1158.
22.	Kjeldsen SE, Jamerson KA, Bakris GL, et al. Predictors of blood pressure response to intensified and fixed combination treatment of hypertension: The ACCOMPLISH study. Blood Pressure, 2008, 17(1): 7-17.
23.	Levy D, Salomon M, D’Agostino RB, et al. Prognostic implications of baseline electrocardiographic features and their serial changes in subjects with left ventricular hypertrophy. Circulation, 1994, 90(4): 1786-1793.
24.	Devereux RB, Dahlof B, Gerdts E, et al. Regression of hypertensive left ventricular hypertrophy by losartan compared with atenolol: the Losartan Intervention for Endpoint Reduction in Hypertension （LIFE) trial. Circulation, 2004, 110(11): 1456-1462.
25.	Devereux RB, Wachtell K, Gerdts E, et al. Prognostic significance of left ventricular mass change uring treatment of hypertension. JAMA, 2004, 292(19): 2350–2356.
26.	Levey AS, Greene T, Beck GJ, et al. Dietary protein restriction and the progression of chronic renal disease: what have all of the results of the MDRD study shown? Modification of Diet in Renal Disease Study group. J Am Soc Nephrol, 1999, 10(11): 2426-2439.
27.	Pohl MA, Blumenthal S, Cordonnier DJ, et al. Independent and additive impact of blood pressure control and angiotensin II receptor blockade on renal outcomes in the irbesartan diabetic nephropathy trial: clinical implications and limitations. J Am Soc Nephrol, 2005, 16(10): 3027-3037.

1. Chobanian AV, Bakris GL, Black HR, et al. National High Blood Pressure Education Program Coordinating Committee. JAMA, 2003, 289(19): 2560-2571.
2. Guibert JJ. The world health report 2002: reducing risks, promoting healthy life. Edu Health, 2003, 16(2): 230.
3. 中国高血压防治指南修订委员会. 2005年中国高血压防治指南 (试用本). 中华心血管病杂志, 2004, 32(12): 1060-1064.
4. 肖卓殷, 肖蓉. 醋柳黄酮类的化学研究. 四川医学院学报, 1980, 11(3): 174.
5. 章茂顺. 醋柳总黄酮治疗缺血性心脏病对照试验. 中华心血管病杂志, 1987, 15(2): 97.
6. Inal ME, Kahraman A. The protective effect of flavonol quercetin againest ultraviolet a induced oxidative stress in rats. Toxicology, 2000, 154(1-3): 21-29.
7. Kandaswami C, Middleton E Jr. Free radical scavenging and antioxidant activity ofplantflavonoids. Adv ExpMed Biol, 1994, 366(4): 351-376.
8. Perez-Vizcaino F, Ibarra M, Cogoludo AL, et a1. Endotheliumindependent vasedilator efects of the flavonoid quemetin and its methylatedmetabolites in rat conductance and resistance arteriesl. Pharmacol Exp Ther, 2002, 302(1): 66-72.
9. 何军, 陈仪, 肖恒怡, 等. 醋柳黄酮对自发性高血压大鼠主动脉内 MCP-1表达的影响. 四川大学学报(医学版), 2009, 40(3): 481-485.
10. 黄良月. 醋柳黄酮防治冠心病药理基础研究. 华西药学杂志, 1986, 1(2): 163.
11. 曹子寿. 雅达心达康治疗冠心病心绞痛的疗效观察. 临床心血管杂志, 1995, 11(3): 190.
12. 朱福, 胡春燕, 黄波, 等. 醋柳黄酮对自发性高血压大鼠血管平滑肌内游离钙的影响. 中国新药与临床杂志, 2004, 23(8): 501-503.
13. 王美华, 朱福, 陆铭, 等. 醋柳黄酮对高血压病患者肾功能的影响. 中国全科学, 2002, 5(6): 447-448.
14. 徐武华, 陈坚, 邓哲彤. 醋柳黄酮与依那普利治疗高血压的临床对照研究. 中国综合临床, 2001, 1(12): 903-904.
15. 廖晓阳, 张茂顺, 王伟文, 等. 醋柳黄酮对原发性高血压患者一氧化氮, 内皮素的影响. 华西医学, 2005, 20(2): 247-248.
16. 龚铭, 廖晓阳, 章茂顺, 等. 醋柳黄酮对高血压游离钙及胰岛素敏感性的影响. 现代中西医结合杂志, 2000, 9(14): 1303.
17. 张新军, 章茂顺, 王家良, 等. 醋柳黄酮对高血压患者交感神经兴奋性的影响, 四川大学学报(医学版), 2001, 32(4): 547.
18. 韩清华, 张庚天, 尚美生. 醋柳黄酮对高血压病患者左心室肥厚的逆转作用. 中国中西医结合杂志, 2001, 21(3): 215.
19. Mancia, Giuseppe, De Backer, et al. 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension（ESH) and of the European Society of Cardiology （ESC). Journal of Hypertension, 2007, 25(6): 1105-1187.
20. Hansson L, Zanchetti A, Carruthers SG, et al. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment（HOT) randomized trial. Lancet, 1998, 351(9118): 1755-1762.
21. Sever PS, Poulter NR, Wedel H, et al. revention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial--Lipid Lowering Arm （ASCOT-LLA): a multicentre randomized controlled trial. Lancet, 2003, 361(9364): 1149-1158.
22. Kjeldsen SE, Jamerson KA, Bakris GL, et al. Predictors of blood pressure response to intensified and fixed combination treatment of hypertension: The ACCOMPLISH study. Blood Pressure, 2008, 17(1): 7-17.
23. Levy D, Salomon M, D’Agostino RB, et al. Prognostic implications of baseline electrocardiographic features and their serial changes in subjects with left ventricular hypertrophy. Circulation, 1994, 90(4): 1786-1793.
24. Devereux RB, Dahlof B, Gerdts E, et al. Regression of hypertensive left ventricular hypertrophy by losartan compared with atenolol: the Losartan Intervention for Endpoint Reduction in Hypertension （LIFE) trial. Circulation, 2004, 110(11): 1456-1462.
25. Devereux RB, Wachtell K, Gerdts E, et al. Prognostic significance of left ventricular mass change uring treatment of hypertension. JAMA, 2004, 292(19): 2350–2356.
26. Levey AS, Greene T, Beck GJ, et al. Dietary protein restriction and the progression of chronic renal disease: what have all of the results of the MDRD study shown? Modification of Diet in Renal Disease Study group. J Am Soc Nephrol, 1999, 10(11): 2426-2439.
27. Pohl MA, Blumenthal S, Cordonnier DJ, et al. Independent and additive impact of blood pressure control and angiotensin II receptor blockade on renal outcomes in the irbesartan diabetic nephropathy trial: clinical implications and limitations. J Am Soc Nephrol, 2005, 16(10): 3027-3037.

Chinese Journal of Evidence-Based Medicine

Total Flavones of Hippophae Rhamnoides L. for Essential Hypertension: A Systematic Review of Randomized Controlled Trials

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