可能對一般網友(指沒有任何醫學背景的)來說,找到原文有困難.但是健康壇老T就很認真,能檢索到根源.
鏈接:
American Heart Association有關高血壓替代療法的原文摘要abstract
American Heart Association有關高血壓替代療法研究的全文pdf
下麵是專家的看法(到底同意了哪些?我拷貝了全文供大家思考.可惜我沒時間去翻譯,是英文的):
來源:
Experts Agree Alternative Therapies May Lower BP
Published: Apr 23, 2013 | Updated: Apr 24, 2013
How many times have your patients asked if there's anything besides medication that has been proven to help to lower blood pressure?
It's a common question, and now, for the first time, you can reply that a group of experts has reviewed all the existing studies and concluded that indeed there are alternative treatments for lowering blood pressure – with aerobic exercise leading the pack as far as strong evidence goes.
Other alternative treatments – namely isometric handgrip and dynamic resistance exercises and guided breathing -- also got high grades when it came to reducing high blood pressure in some patients, according to a scientific statement from the American Heart Association published online in the journal Hypertension.
"The evidence is not as strong for transcendental meditation and acupuncture, but they may help as well," said co-senior author Sanjay Rajagopalan, MD, professor of cardiovascular medicine at Ohio State University School of Medicine in Columbus. The main reason they did not receive a stronger recommendation is because research into these strategies is still limited, he explained.
The news will no doubt be welcomed -- one person in four has hypertension. That makes it the leading cause of heart disease and stroke, contributing to more than 13% of premature deaths, Rajagopalan said in an interview. Moreover, prehypertension is a leading problem as well and that "goes hand in hand with diabetes," he said.
For the report, an expert panel headed by the University of Michigan's Robert D. Brook, MD, reviewed 1,000 studies published from 2006 to 2011. They divided the studies into three major classes of alternative treatments: behavioral therapies, noninvasive procedures and devices, and exercise. The panel did not review dietary and herbal treatments.
Based on the level of evidence, they gave each an "A," "B," or "C" recommendation -- with "A" being the highest -- for implementation into clinical practice.
Overall, there was an unexpectedly high level of evidence supporting some of the alternative methods, Rajagopalan said. There were remarkably few studies or conflicting results with regard to others of the techniques, he said.
The panel found:
Exercise-based regimens did the best overall, with dynamic aerobic exercises getting an "A" class of recommendation, with a level of evidence of I, the highest possible.
Dynamic resistance exercises got a "B" and isometric handgrip exercises got a "C" grade, with levels of evidence of IIA and IIB, respectively.
Still, 4 weeks of isometric hand grip exercises resulted in some of the most impressive improvements in several studies -- a 10% drop in systolic and diastolic blood pressure, the panel noted.
However, they noted, isometric exercise should be avoided among people with severely uncontrolled hypertension (180/110 mm Hg or higher), they added.
As for noninvasive procedures or devices, device-guided breathing got a "B" with a II for level of evidence. Device-guided slow breathing proved most effective in lowering blood pressure when performed for 15-minute sessions three to four times a week, the panel noted.
Acupuncture also got a "B," but its level of evidence was III, meaning no benefit.
"That's not to say there were no studies showing benefit; more research is needed," Rajagopalan said.
Among behavioral techniques, transcendental meditation and biofeedback both received "B" grades, with IIBs for levels of evidence. Yoga got a C, with a III level of evidence, or no benefit, as did other meditation techniques.
Overall though, Rajagopalan said, even the alternative approaches that work reduce systolic blood pressure by only 2 to 10 mm Hg; whereas standard doses of a blood pressure-lowering drug reduce systolic blood pressure by about 10 to 15 mm Hg.
Alternative approaches are best for patients with blood pressure levels over 120/80 mm Hg who can't tolerate or don't respond well to standard medications, he said.
How most of the strategies work to reduce blood pressure is still unclear, the panel noted, although exercise appears to relax and widen blood vessels.
"It is the consensus of the writing group that it is reasonable for all patients with blood pressure levels higher than 120/80 mm Hg to consider trials of alternative approaches as adjuvant methods to help lower blood pressure when clinically appropriate," the panel concluded.
A suggested management algorithm -- along with recommendations for prioritizing usage of the individual approaches in clinical practice based upon their level of evidence in the paper -- appears online in the journal.
Christine Lawless, MD, co-chairman of the American College of Cardiology's Sports and Exercise Council, had high praise for the report.
"This was a fantastic review with an incredible amount of work going into finding and reviewing all these studies. Many of us prescribe some sort of exercise, so I was glad to see they gave it such a high level of evidence," she said in an interview.
"It will be interesting to see if insurance now covers it," added Lawless, of the University of Chicago.
She added that she also recommends yoga and doesn't plan to stop despite its lower grade. "It has a lot of benefits beyond lowering blood pressure," she said.
The panel agreed: "It is also important to re-emphasize that many of the reviewed alternative therapies (e.g., resistance and aerobic exercise, yoga, meditation, acupuncture) may provide a range of health or psychological benefits beyond BP-lowering or CV risk reduction," they said.
Do you already recommend alternative methods for lowering BP to your patients? If not, will you now that this expert review has been published? Click on Add Your Knowledge to express your view and see what others are saying. -- Sanjay Gupta, MD
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