Hypertension is a common clinical cardiovascular disease with systemic arterial pressure increase as the main sign, which not only causes headache, dizziness, and other clinical symptoms but also damages important organs such as the heart, brain, kidney and eyes, and it further produces multiple system lesions or dysfunction [
Qiju Dihuang Decoction (QDD), recorded in the Qing Dynasty
This study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) [
Randomized controlled trials (RCTs) that evaluated the effect of QDD for hypertension were searched in the following 7 electronic databases: the Chinese National Knowledge Infrastructure (CNKI, from 1980 to 2020), Chinese Biomedical Literature Database (CBM, from 1978 to 2020), Wanfang Database (from 1998 to 2020), Weipu Database (from 1989 to 2020), PubMed (from 1959 to 2020), and Web of Science (from 1986 to 2020) and Springerlink (from 1996 to 2020). We used the following terms “blood pressure” OR “high blood pressure” OR “hypertension” OR “essential hypertension” OR “primary hypertension” OR “
Trials were considered eligible for inclusion if the diagnosis of hypertension in the patients conformed to the diagnostic criteria established by the World Health Organization or International Hypertension Federation or the guidelines for the prevention and treatment of hypertension in China. And patients were not restricted by age, gender, or nationality. Studies were excluded if (a) the diagnostic criteria of the study object were unclear; (b) the patient had secondary hypertension; (c) the patient was accompanied by other adverse states (such as depression, insomnia, and perimenopause); (d) the patient was pregnant.
The intervention measures in the treatment group should be QDD alone or in combination with other antihypertensive treatments. And, the control group should be other antihypertensive treatments or placebo, such as conventional therapy, conventional antihypertensive drugs, and lifestyle interventions (CADLI). However, trials involving qigong, TAI Chi, acupuncture, moxibustion, massage, and cupping as common interventions will be excluded.
The primary outcome was defined as blood pressure, which included antihypertensive effects, systolic blood pressure (SBP), and diastolic blood pressure (DBP). The secondary outcomes included clinical effects, TCM syndrome score, life quality, 24 h ambulatory blood pressure, angiotensin II (Ang II), endothelin (ET), insulin sensitivity index (ISI), insulin (INS), mA1b,
This study included a randomized controlled trial using QDD to treat hypertension in the experimental group. Studies were excluded if (a) they were not random; (b) no control group was used; (c) the experimental design was not rigorous and statistical methods are inappropriate; (d) it was on the indeterminacy of measurement index outcome criterion; (e) they failed to obtain effective analysis data; (f) they were animal experiments; (g) they were plagiarized.
Two researchers independently screened the titles and abstracts of potential eligible studies, and then they retrieved and reviewed the full text of the possible studies based on the inclusion and exclusion criteria and extracted the data. If there was disagreement, they agreed through discussion or submitted it to a third party for evaluation. Data extraction table mainly included the basic information of the study (author’s name, title of the study, year of publication, country/region, and publication status), study characteristics (sample size, source of cases, age, gender distribution, diagnostic criteria, and inclusion and exclusion criteria), intervention and control measures (dosage form, dose, and duration), research methodology (random scheme generation, allocation hiding, blind method, incomplete result data, selective reporting, other biases, and loss of follow-up), and outcome measures.
According to the Cochrane collaboration tool, two reviewers independently evaluated the methodological quality of each included study. It comprised the following seven aspects: random sequence generation, allocation concealment, blind method, incomplete result data, selective reporting, and other biases [
Statistical analysis was performed using Rev Man 5.3 software. The results of a single study were firstly described. The binomial variables were described by using relative risk (RR) and 95% confidence interval (CI), and the continuous variables were described by mean difference (MD) and 95% CI to describe the effect value of the intergroup comparison. Heterogeneity was judged on the basis of the results of
Based on the retrieval strategy, 383 potential relevant literatures on the treatment of hypertension by QDD were preliminarily searched in 7 databases, and 244 literatures were retrieved after 139 copies were removed. After reviewing the titles and abstracts, 189 articles were excluded because they did not comply with the inclusion criteria and 55 articles initially met the intended criteria. After reading the full text, 19 eligible studies were included for meta-analysis [
Flow diagram of literature selection.
Table
Characteristic of the 19 trials included in the meta-analysis.
Author(s) | Sample size (experimental/control) | Gender (male/female) | Diagnostic criteria | Experimental | Control | Duration | Outcome measures |
---|---|---|---|---|---|---|---|
Du et al. [ | 60/60 | 66/54 | WHO-ISHNGMH-1999 | QDD (6 g, tid) + C | Felodipine sustained release tablet (5 mg, qd) | 1 month | BP, Ang II, ET |
Du et al. [ | 30/30 | 31/29 | DCPTHC | QDD (9 g, bid) + C | Nifedipine delayed-release tablet (30 mg, qd) | 1 month | AE, BP |
Guo and Li [ | 40/40 | 46/34 | DCPTHC | Modified QDD (1 dose/d) + C | Nifedipine delayed-release tablet (10 mg, bid), captopril tablet (25 mg, bid) | 1 month | AE, BP |
Huang [ | 40/40 | NR | DCPTHC | QDD (9 g, bid) + C | Nifedipine tablet (30 mg, qd) | 1 month | AE, BP |
Liang [ | 133/132 | 128/137 | WHO-ISHNGMH-1999 | QDD (6 g, bid) + C | CADLI | 6 months | AE |
Li et al. [ | 50/50 | 49/51 | WHO-ISHNGMH-1999 | Modified QDD (1 dose/d) | Conventional treatment (nao liqing, luo buma tablet, and dihydrochlorothiazide) | 3 months | AE |
Liu [ | 50/50 | 47/53 | WHO-ISHNGMH-1999 | Modified QDD (1 dose/d) + C | Amlodipine besylate tablet (5 mg, qd) | 1 month | BP, CE, QL |
Liu et al. [ | 219/114 | 159/174 | GDTCDIMCM | Modified QDD (1 dose/d) | Conventional treatment (nao liqing, luo buma tablet, and dihydrochlorothiazide) | 3 months | AE |
Lu [ | 40/40 | 48/32 | WHO-ISHNGMH-1999 | Modified QDD (1 dose/d) | Captopril tablet (25 mg, tid) | NR | AE |
Luo and Luo [ | 60/60 | 65/55 | WHO-ISHNGMH-1999 | Modified QDD (1 dose/d) | Nitrondipine tablet (10 mg, tid) | 2 months | AE, BP |
Peng et al. [ | 30/30 | 34/26 | WHO-ISHNGMH-1999 | QDD (1 dose/d) | Losartan potassium tablet (50 mg, qd) | 2 months | BP, ISI, INS |
Song [ | 36/36 | 42/30 | WHO-ISHNGMH-1999 | Modified QDD (1 dose/d) + C | Amlodipine besylate tablet (5 mg, qd) | 1 month | BP, CE, TCMSS, QL |
Sun et al. [ | 32/31 | 26/37 | WHO-ISHNGMH-1999 | QDD (1.5 g, tid) + C | Telmisartan tablet (40 mg, qd) | 1 month | AE |
Wang [ | 60/30 | 48/42 | WHO-ISHNGMH-1999 | Modified QDD (1 dose/d) + C | Irbesartan tablet (150 mg, qd) | 2 months | BP, mA1b |
Wang et al. [ | 40/40 | 41/39 | DCPTHC | QDD (9 g, bid) + C | Enalapril maleate and folic acid tablet (0.8 mg, qd) | 1 month | AE, 24 h ABP |
Yang and He [ | 40/40 | 46/34 | DCPTHC | Modified QDD (1 dose/d) + C | Enalapril maleate capsules (5 mg, bid) | 3 months | AE |
Yu [ | 50/50 | 68/32 | DCPTHC | QDD (1 dose/d) + C | Conventional antihypertensive drugs (ACEI, ARB, CCB, and diuretic) | 1 month | AE, Ang II, HsCRP |
Zhang [ | 34/34 | 30/32 | WHO-ISHNGMH-1999 | QDD (1 dose/d) + C | Amlodipine besylate tablet (5 mg, qd) | 1 month | AE, BP |
Zhu [ | 46/46 | 49/43 | DCPTHC | QDD (9 g, bid) + C | Nifedipine controlled release tablet (30 mg, qd) | 2 months | AE, BP |
The ingredients of Qiju Dihuang Decoction used in the 19 trials.
References | TCM | Ingredients of QDD |
---|---|---|
Du et al. [ | QDD (6 g, tid) | Rehmanniae Radix Praeparata (Shudihuang), Corni Fructus (Shanzhuyu), Dioscoreae Rhizoma (Shanyao), Poria (Fuling), Moutan Cortex (Mudanpi), Alismatis Rhizoma (Zexie), Lycii Fructus (Gouqizi), Chrysanthemi Flos (Juhua) |
Du et al. [ | QDD (9 g, bid) | Rehmanniae Radix Praeparata (Shudihuang), Corni Fructus (Shanzhuyu), Dioscoreae Rhizoma (Shanyao), Poria (Fuling), Moutan Cortex (Mudanpi), Alismatis Rhizoma (Zexie), Lycii Fructus (Gouqizi), Chrysanthemi Flos (Juhua) |
Guo and Li [ | Modified QDD (1 dose/d) | Rehmanniae Radix (Shengdi) 12 g, Corni Fructus (Shanzhuyu) 9 g, Dioscoreae Rhizoma (Shanyao) 9 g, Poria (Fuling) 6 g, Moutan Cortex (Mudanpi) 6 g, Alismatis Rhizoma (Zexie) 6 g, Lycii Fructus (Gouqizi) 9 g, White Chrysanthemi Flos (Baijuhua) 12 g, Gastrodiae Rhizoma (Tianma) 9 g, Uncariae Ramulus Cum Uncis (Gouteng) 9 g, Haliotidis Concha (Shijueming) 15 g |
Huang [ | QDD (9 g, bid) | Rehmanniae Radix Praeparata (Shudihuang), Corni Fructus (Shanzhuyu), Dioscoreae Rhizoma (Shanyao), Poria (Fuling), Moutan Cortex (Mudanpi), Alismatis Rhizoma (Zexie), Lycii Fructus (Gouqizi), Chrysanthemi Flos (Juhua) |
Liang [ | QDD (6 g, bid) | Rehmanniae Radix Praeparata (Shudihuang), Corni Fructus (Shanzhuyu), Dioscoreae Rhizoma (Shanyao), Poria (Fuling), Moutan Cortex (Mudanpi), Alismatis Rhizoma (Zexie), Lycii Fructus (Gouqizi), Chrysanthemi Flos (Juhua) |
Li et al. [ | Modified QDD (1 dose/d) | Lycii Fructus (Gouqizi) 15 g, Hordei Fructus Germinatus (Shengmaiya) 15g, Chrysanthemi Flos (Juhua) 15 g, Poria (Fuling) 15 g, Rehmanniae Radix Praeparata (Shudihuang) 15 g, Alismatis Rhizoma (Zexie) 10 g, Corni Fructus (Shanzhuyu) 15 g, Dioscoreae Rhizoma (Shanyao) 15 g, Moutan Cortex (Mudanpi) 10 g, Glehniae Radix (Beishashen) 30 g, Cyathulae Radix (Chuanniuxi) 30 g, Haliotidis Concha (Shijueming) 30 g, Ostreae Concha (Shengmuli) 30 g, Raw keel (Shenglonggu) 30 g, Glycyrrhizae Radix et Rhizoma (Gancao) 6 g |
Liu [ | Modified QDD (1 dose/d) | Rehmanniae Radix Praeparata (Shudihuang) 10 g, White Chrysanthemi Flos (Baijuhua) 12 g, Lycii Fructus (Gouqizi) 15 g, Poria (Fuling) 15 g, Chinese yam (Shanyao) 15 g, Moutan Cortex (Mudanpi) 12 g, Corni Fructus (Shanzhuyu) 12 g, Alismatis Rhizoma (Zexie) 12 g, Cyathulae Radix (Niuxi) 12 g, Uncariae Ramulus Cum Uncis (Gouteng) 12 g, Gastrodiae Rhizoma (Tianma) 10 g, Magnetitum (Cishi) 30 g |
Liu et al. [ | Modified QDD (1 dose/d) | Lycii Fructus (Gouqizi) 15 g, Chrysanthemi Flos (Juhua) 15 g, Rehmanniae Radix Praeparata (Shudihuang) 15 g, Corni Fructus (Shanzhuyu) 15 g, Dioscoreae Rhizoma (Shanyao) 15 g, Radix glehniae (Beishashen) 30 g, Haliotidis Concha (Shijueming) 30 g, Raw keel (Shenglonggu) 30 g, Ostreae Concha (Shengmuli) 30 g, Cyathulae Radix (Chuanniuxi) 30 g, Moutan Cortex (Mudanpi) 10 g, Alismatis Rhizoma (Zexie) 10 g, Poria (Fuling) 15 g, Hordei Fructus Germinatus (Shengmaiya) 15 g, Glycyrrhizae Radix et Rhizoma (Gancao) 6 g |
Lu [ | Modified QDD (1 dose/d) | Lycii Fructus (Gouqizi) 25 g, Chrysanthemi Flos (Juhua) 15 g, Rehmanniae Radix Praeparata (Shudihuang) 15 g, Taxilli Herba (Sangjisheng) 15 g, Tortoise plastron (Guiban) 15 g, Cyathulae Radix (Niuxi) 15 g, Dioscoreae Rhizoma (Shanyao) 15 g, Poria (Fuling) 15 g, Corni Fructus (Shanzhuyu) 10 g, Moutan Cortex (Mudanpi) 10 g, Haliotidis Concha (Shijueming) 20 g |
Luo and Luo [ | Modified QDD (1 dose/d) | Rehmanniae Radix Praeparata (Shudihuang) 15 g, Corni Fructus (Shanzhuyu) 12 g, Dioscoreae Rhizoma (Shanyao) 15 g, Poria (Fuling) 10 g, Moutan Cortex (Mudanpi) 10 g, Alismatis Rhizoma (Zexie) 10 g, Lycii Fructus (Gouqizi) 15 g, White Chrysanthemi Flos (Baijuhua) 10 g, Ostreae Concha (Shengmuli) 15 g, Raw keel (Shenglonggu) 15 g, Haliotidis Concha (Shijueming) 10 g, Maybush (Shanzha) 15 g |
Peng et al. [ | QDD (1 dose/d) | Rehmanniae Radix Praeparata (Shudihuang), Corni Fructus (Shanzhuyu), Dioscoreae Rhizoma (Shanyao), Poria (Fuling), Moutan Cortex (Mudanpi), Alismatis Rhizoma (Zexie), Lycii Fructus (Gouqizi), Chrysanthemi Flos (Juhua) |
Song [ | Modified QDD (1 dose/d) | Rehmanniae Radix Praeparata (Shudihuang) 10 g, White Chrysanthemi Flos (Baijuhua) 12 g, Lycii Fructus (Gouqizi) 15 g, Poria (Fuling) 15 g, Dioscoreae Rhizoma (Shanyao) 15 g, Moutan Cortex (Mudanpi) 12 g, Corni Fructus (Shanzhuyu) 12 g, Alismatis Rhizoma (Zexie) 12 g, Cyathulae Radix (Niuxi) 12 g, Gastrodiae Rhizoma (Tianma) 10 g, Uncariae Ramulus Cum Uncis (Gouteng) 12 g, Magnetitum (Cishi) 30 g |
Sun et al. [ | QDD (1.5 g, tid) | Rehmanniae Radix Praeparata (Shudihuang), Corni Fructus (Shanzhuyu), Dioscoreae Rhizoma (Shanyao), Poria (Fuling), Moutan Cortex (Mudanpi), Alismatis Rhizoma (Zexie), Lycii Fructus (Gouqizi), Chrysanthemi Flos (Juhua) |
Wang [ | Modified QDD (1 dose/d) | Rehmanniae Radix Praeparata (Shudihuang) 10 g, White Chrysanthemi Flos (Baijuhua) 15 g, Lycii Fructus (Gouqizi) 15 g, Poria (Fuling) 15 g, Dioscoreae Rhizoma (Shanyao) 30 g, Moutan Cortex (Mudanpi) 15 g, Corni Fructus (Shanzhuyu) 30 g, Alismatis Rhizoma (Zexie) 15 g, Cyathulae Radix (Niuxi) 15 g, Gastrodiae Rhizoma (Tianma) 10 g, Tortoise plastron (Guiban) 15 g |
Wang et al. [ | QDD (9 g, bid) | Rehmanniae Radix Praeparata (Shudihuang), Corni Fructus (Shanzhuyu), Dioscoreae Rhizoma (Shanyao), Poria (Fuling), Moutan Cortex (Mudanpi), Alismatis Rhizoma (Zexie), Lycii Fructus (Gouqizi), Chrysanthemi Flos (Juhua) |
Yang and He [ | Modified QDD (1 dose/d) | Rehmanniae Radix (Shengdi) 12 g, Corni Fructus (Shanzhuyu) 9 g, Dioscoreae Rhizoma (Shanyao) 9 g, Poria (Fuling) 6 g, Moutan Cortex (Mudanpi) 6 g, Alismatis Rhizoma (Zexie) 6 g, Lycii Fructus (Gouqizi) 9 g, White Chrysanthemi Flos (Baijuhua) 12 g, Gastrodiae Rhizoma (Tianma) 9 g, Uncariae Ramulus Cum Uncis (Gouteng) 9 g, Haliotidis Concha (Shijueming) 15 g, Paeoniae Radix Rubra (Chishao) 9 g, Salviae Miltiorrhizae Radix et Rhizoma (Danshen) 30 g |
Yu [ | QDD (1 dose/d) | Rehmanniae Radix Praeparata (Shudihuang), Corni Fructus (Shanzhuyu), Dioscoreae Rhizoma (Shanyao), Poria (Fuling), Moutan Cortex (Mudanpi), Alismatis Rhizoma (Zexie), Lycii Fructus (Gouqizi), Chrysanthemi Flos (Juhua) |
Zhang [ | QDD (1 dose/d) | Rehmanniae Radix Praeparata (Shudihuang), Corni Fructus (Shanzhuyu), Dioscoreae Rhizoma (Shanyao), Poria (Fuling), Moutan Cortex (Mudanpi), Alismatis Rhizoma (Zexie), LyciiFructus (Gouqizi), Chrysanthemi Flos (Juhua) |
Zhu [ | QDD (9 g, bid) | Rehmanniae Radix Praeparata (Shudihuang), Corni Fructus (Shanzhuyu), Dioscoreae Rhizoma (Shanyao), Poria (Fuling), Moutan Cortex (Mudanpi), Alismatis Rhizoma (Zexie), Lycii Fructus (Gouqizi), Chrysanthemi Flos (Juhua) |
Table
Methodology quality of the 19 studies according to the Cochrane handbook.
References | A | B | C | D | E | F | G | H |
---|---|---|---|---|---|---|---|---|
Du et al. [ | + | ? | ? | ? | ? | + | ? | ? |
Du et al. [ | ? | ? | ? | ? | ? | + | ? | ? |
Guo and Li [ | ? | ? | ? | ? | ? | + | ? | ? |
Huang [ | − | ? | ? | ? | ? | + | ? | ? |
Liang [ | ? | ? | ? | ? | ? | + | ? | ? |
Li et al. [ | ? | ? | ? | ? | ? | + | ? | ? |
Liu [ | ? | ? | ? | ? | ? | + | ? | ? |
Liu et al. [ | ? | ? | ? | ? | ? | + | ? | ? |
Lu [ | + | ? | ? | ? | ? | + | ? | ? |
Luo and Luo [ | + | ? | ? | ? | ? | + | ? | ? |
Peng et al. [ | ? | ? | ? | ? | ? | + | ? | ? |
Song [ | ? | ? | ? | ? | ? | + | ? | ? |
Sun et al. [ | + | ? | ? | ? | ? | + | ? | ? |
Wang [ | ? | ? | ? | ? | ? | + | ? | ? |
Wang et al. [ | ? | ? | ? | ? | ? | + | ? | ? |
Yang and He [ | + | ? | ? | ? | ? | + | ? | ? |
Yu [ | ? | ? | ? | ? | ? | + | ? | ? |
Zhang [ | ? | ? | ? | ? | ? | + | ? | ? |
Zhu [ | ? | ? | ? | ? | ? | + | ? | ? |
The antihypertensive effect was formulated in accordance with the criteria for the diagnosis and efficacy of TCM diseases [
Forest plot of the trials showed antihypertensive effects in different interventions for (a) QDD vs
Meta-analysis of 11 trials reported the changes in blood pressure levels before and after treatment [
Forest plot of the trials showed blood pressure in different interventions for (a) DBP, QDD vs. AD, (b) SBP, QDD vs
Clinical effect was determined by the TCM syndrome score. The clinical symptoms were significantly alleviated, and the TCM syndrome score was decreased by > 70% after treatment, indicating an obvious effect. At the same time, the TCM syndrome score was decreased by 50∼70% for improvement. No improvement or aggravation of symptoms and a reduction of TCM syndrome score below 50% is invalid. Obvious effect was used as an indicator of clinical efficacy. Two trials [
Forest plot of the trials showed clinical effects in QPAD vs. AD; Abbreviations: AD: antihypertensive drugs; QPAD: Qiju Dihuang decoction plus antihypertensive drugs.
The scoring method of TCM syndromes refers to the guiding principles for clinical research of new Chinese medicine [
SF-36 was used to evaluate the life quality of patients. And, the higher the score, the higher the life quality.
2 trials reported changes in patients’ life quality before and after treatment [
Forest plot of the trials showed life quality in QPAD vs. AD. Abbreviations: AD: antihypertensive drugs; QPAD: Qiju Dihuang decoction plus antihypertensive drugs.
24 h ambulatory blood pressure was only reported in one trial [
Ang II at baseline and after intervention was reported by 2 trials [
Only 1 trial described ET [
Only one trial reported ISI at baseline and after intervention [
INS level was also reported by the same trial as ISI, revealing that the reduction in INS was obviously greater for QPAD than that of antihypertensive drugs alone (1 trial,
Only 1 trial reported mA1b at baseline and after intervention [
The effect of QPAD on
The same trial also reported the NAG level, in which QPAD was compared with antihypertensive drugs, and it was found to have a significant lowering effect in NAG (1 trial,
The HsCRP level at baseline and postintervention was reported by 1 trial that compared QPAD with antihypertensive drugs [
No adverse reactions were reported in all trials.
Since fewer than 10 trials were included in each subgroup, publication bias could not be adequately analyzed.
TCM has certain advantages and characteristics in the treatment of hypertension. In recent years, the classic TCM formulae for treating hypertension have attracted much attention [
This systematic review and meta-analysis contained 19 trials and 2043 patients with hypertension, which evaluated the efficacy of QDD in the treatment of hypertension, including QDD vs
Patients with long-term hypertension will lead to a variety of pathophysiological changes, which will not only cause headache, chest tightness, palpitations, and other symptoms but also may involve various organs and cause different complications. Therefore, hypertension is a major predisposing factor for many high-risk diseases. Many studies have also showed that the treatment of hypertension can play a preventive role in the occurrence of cardiovascular and cerebrovascular diseases [
This study also discovered the potential mechanism of QDD for the reduction of blood pressure and the prevention of complications. Ang II vascular remodeling is one of the important pathological changes in the pathogenesis of hypertension, such as vascular smooth muscle proliferation, apoptosis, and other lesions, which will damage vascular walls, decrease vascular compliance, and lead to the imbalance of vascular active substances and disorder hemodynamic, all of which will lead to increase blood pressure. And, it was also reported to regulate the constriction of arterioles throughout the body and increase blood pressure [
QDD contains 8 single TCMs, including Lycii Fructus (Gouqizi), Chrysanthemi Flos (Juhua), Rehmanniae Radix Praeparata (Shudihuang), Dioscoreae Rhizoma (Shanyao), Corni Fructus (Shanzhuyu), Moutan Cortex (Mudanpi), Poria (Fuling), and Alismatis Rhizoma (Zexie). Anthocyanins from Gouqi (Figure
Chemical structures of the main active ingredients of QDD. (a) Anthocyanins from Gouqi, (b) cynaroside from Juhua, (c) diosgenin from Shanyao, (d) morroniside from Shanzhuyu, (e) paeonol from Mudanpi, (f) alisol A from Zexie, (g) alisol B from Zexie, and (h) alisol B 23-acetat from Zexie; abbreviations: QDD: Qiju Dihuang decoction.
Hypertension belongs to vertigo or headache in TCM, and it often follows other symptoms according to its complex etiology. So, its treatment should consider the alleviation of some relative symptoms. Our research results showed that QPAD could significantly decrease the TCM syndrome score of patients and improve the life quality of patients. So, it has an obvious effect on reducing the clinical symptoms.
With the accelerating pace of our life, the incidence of hypertensive patients increases year by year and shows a trend of becoming younger [
Although the effects of QDD on hypertension were evaluated using a meta-analysis, there were some limitations. Firstly, though all of 19 included trials reported randomization, only 6 trials had the random number table. In 19 trials, one used a medical order and the rest of the test randomness was not clear. However, all trials had some deficiencies such as random allocation concealment, blinding of participants, personnel and outcome assessors, or selective outcome reporting. Secondly, no publication bias had been evaluated, because the number of trials included in each subgroup was too small (no more than 10). And, regarding the efficacy of QPAD for SBP, there was a greater heterogeneity among the 7 included trials. Thirdly, there are still 9 trials using modified QDD that does not exactly reflect the effect of QDD. Fourthly, QDD is widely used in the treatment of ophthalmic diseases in the clinic [
In summary, this study identified that QDD can significantly reduce the blood pressure of hypertension patients and improve the antihypertensive effects; furthermore, it shows a significant ET-lowering effect. Combining with antihypertensive drugs, it can also exhibit an obvious reduction on TCM syndrome score and average blood pressure of 24 h, Ang ?, INI, mA1b,
Angiotensin II
Conventional antihypertensive drugs and lifestyle interventions
Confidence interval
Diastolic blood pressure
Endothelin
High-sensitivity C-reactive protein
Insulin
Insulin sensitivity index
Mean difference
Qiju Dihuang Decoction
Qiju Dihuang Decoction plus antihypertensive drugs
Qiju Dihuang Decoction plus conventional antihypertensive drugs and lifestyle interventions
Randomized controlled trials
Relative risk
Systolic blood pressure
Traditional Chinese medicine.
The data used to support the findings of this study are available from the corresponding author upon request.
The authors declare that they have no conflicts of interest.
Shuo Zhang and Xue Bai designed the study, conducted the statistical analysis, drew the tables and pictures, and drafted the full text; Zhen-lin Chen, Jia-jia Li, Yan-yan Chen, and Yu-ping Tang helped to retrieve the database, screen the trials, extract the data, and modify the text.
This study was funded by the National Natural Science Foundation of China (81773882 and 81974584) and Key Research and Development Program of Shaanxi Province (2019ZDLSF04-05 and 2019SF-295). This research was also financially supported by Subject Innovation Team of Shaanxi University of Chinese Medicine (2019-YL10).