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The relation between antihypertensive treatment and progression of cerebral small vessel disease: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND: Cerebral small vessel disease is relevant to hypertension. We tried to figure out whether antihypertensive treatment is beneficial for this disease. METHODS: We systematically searched PubMed, Embase, and Cochrane electronic databases for randomized controlled trials about white matter h...

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Autores principales: Su, Chen, Wu, Hao, Yang, Xiaoyu, Zhao, Bing, Zhao, Renliang
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8322490/
https://www.ncbi.nlm.nih.gov/pubmed/34397717
http://dx.doi.org/10.1097/MD.0000000000026749
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author Su, Chen
Wu, Hao
Yang, Xiaoyu
Zhao, Bing
Zhao, Renliang
author_facet Su, Chen
Wu, Hao
Yang, Xiaoyu
Zhao, Bing
Zhao, Renliang
author_sort Su, Chen
collection PubMed
description BACKGROUND: Cerebral small vessel disease is relevant to hypertension. We tried to figure out whether antihypertensive treatment is beneficial for this disease. METHODS: We systematically searched PubMed, Embase, and Cochrane electronic databases for randomized controlled trials about white matter hyperintensities (WMH), brain atrophy, microbleeds, and lacunar infarcts with antihypertensive treatment and performed a meta-analysis. RESULTS: We identified 7 trials on white matter hyperintensities and brain atrophy with antihypertensive treatment. Pooled analysis showed antihypertensive treatment performed positively in the progression of WMH (standardized mean difference, −0.22; 95% CI, −0.36 to −0.07, I^2 = 52%). And in the subgroup meta-analysis, only lower SBP controlled level (110–129 mm Hg) had effect on the progression of WMH (standardized mean difference, −0.37; 95% CI, −0.54 to −0.29, I^2 =0). The meta-regression showed larger difference of SBP in treatment groups having a smaller WMH progression. Antihypertensive treatment is not significant in the progression of brain atrophy (standardized mean difference, −0.02; 95% CI, −0.26 to 0.30, I^2 = 85%). Only 1 trial reported the new patients of lacunar infarcts in the follow-up, no association with antihypertensive treatment (odds ratio, 2.2; 95% CI, 0.4–12.1; P = .36). CONCLUSIONS: Antihypertensive treatment is beneficial for cerebral small vessel disease on white matter hyperintensities progression, but no impact on brain atrophy. And lower SBP level is more effective on the progression of WMH. There is not enough evidence to prove the relationship between antihypertensive treatment and lacunar stroke, microbleeds.
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spelling pubmed-83224902021-08-02 The relation between antihypertensive treatment and progression of cerebral small vessel disease: A systematic review and meta-analysis of randomized controlled trials Su, Chen Wu, Hao Yang, Xiaoyu Zhao, Bing Zhao, Renliang Medicine (Baltimore) 5300 BACKGROUND: Cerebral small vessel disease is relevant to hypertension. We tried to figure out whether antihypertensive treatment is beneficial for this disease. METHODS: We systematically searched PubMed, Embase, and Cochrane electronic databases for randomized controlled trials about white matter hyperintensities (WMH), brain atrophy, microbleeds, and lacunar infarcts with antihypertensive treatment and performed a meta-analysis. RESULTS: We identified 7 trials on white matter hyperintensities and brain atrophy with antihypertensive treatment. Pooled analysis showed antihypertensive treatment performed positively in the progression of WMH (standardized mean difference, −0.22; 95% CI, −0.36 to −0.07, I^2 = 52%). And in the subgroup meta-analysis, only lower SBP controlled level (110–129 mm Hg) had effect on the progression of WMH (standardized mean difference, −0.37; 95% CI, −0.54 to −0.29, I^2 =0). The meta-regression showed larger difference of SBP in treatment groups having a smaller WMH progression. Antihypertensive treatment is not significant in the progression of brain atrophy (standardized mean difference, −0.02; 95% CI, −0.26 to 0.30, I^2 = 85%). Only 1 trial reported the new patients of lacunar infarcts in the follow-up, no association with antihypertensive treatment (odds ratio, 2.2; 95% CI, 0.4–12.1; P = .36). CONCLUSIONS: Antihypertensive treatment is beneficial for cerebral small vessel disease on white matter hyperintensities progression, but no impact on brain atrophy. And lower SBP level is more effective on the progression of WMH. There is not enough evidence to prove the relationship between antihypertensive treatment and lacunar stroke, microbleeds. Lippincott Williams & Wilkins 2021-07-30 /pmc/articles/PMC8322490/ /pubmed/34397717 http://dx.doi.org/10.1097/MD.0000000000026749 Text en Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0 (https://creativecommons.org/licenses/by/4.0/)
spellingShingle 5300
Su, Chen
Wu, Hao
Yang, Xiaoyu
Zhao, Bing
Zhao, Renliang
The relation between antihypertensive treatment and progression of cerebral small vessel disease: A systematic review and meta-analysis of randomized controlled trials
title The relation between antihypertensive treatment and progression of cerebral small vessel disease: A systematic review and meta-analysis of randomized controlled trials
title_full The relation between antihypertensive treatment and progression of cerebral small vessel disease: A systematic review and meta-analysis of randomized controlled trials
title_fullStr The relation between antihypertensive treatment and progression of cerebral small vessel disease: A systematic review and meta-analysis of randomized controlled trials
title_full_unstemmed The relation between antihypertensive treatment and progression of cerebral small vessel disease: A systematic review and meta-analysis of randomized controlled trials
title_short The relation between antihypertensive treatment and progression of cerebral small vessel disease: A systematic review and meta-analysis of randomized controlled trials
title_sort relation between antihypertensive treatment and progression of cerebral small vessel disease: a systematic review and meta-analysis of randomized controlled trials
topic 5300
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8322490/
https://www.ncbi.nlm.nih.gov/pubmed/34397717
http://dx.doi.org/10.1097/MD.0000000000026749
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