睡前服用乙酰水杨酸与早晨服用乙酰水杨酸对血压昼夜节律的影响--系统回顾和荟萃分析。

IF 2.8 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Frontiers in Cardiovascular Medicine Pub Date : 2024-10-22 eCollection Date: 2024-01-01 DOI:10.3389/fcvm.2024.1346265
Abdullah Nadeem, Taruba Rais, Minahil Aamir, Alexander Habte, Tasmiyah Siddiqui, Riyan Imtiaz Karamat, Rabbia Munsab, Ashna Habib
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引用次数: 0

摘要

导言:心血管疾病(CVD)是全球发病率和死亡率的主要原因,而高收缩压(SBP)被认为是一个主要风险因素。阿司匹林(乙酰水杨酸-ASA)一直被认为是预防心血管疾病的药物,这引发了有关其在一级和二级预防中的最佳使用以及理想的给药时间以最大限度地影响昼夜血压节律的问题。以往的研究表明,睡前服用阿司匹林对降低血压有潜在益处,这归因于阿司匹林对肾素-血管紧张素-醛固酮系统和一氧化氮生成的影响。本系统综述和荟萃分析旨在进一步探讨阿司匹林对血压的昼夜节律效应,重点关注给药时间:方法:根据 PRISMA 指南,对 PubMed、Cochrane 图书馆和 clinicaltrials.gov 进行了全面检索。纳入的随机对照试验(RCT)涉及年龄大于 18 岁、有心血管病史和高血压的患者。主要目的是评估睡前和早晨服用阿司匹林对收缩压和舒张压的影响。低剂量阿司匹林用于一级或二级预防。Cochrane 偏倚风险工具对研究质量进行了评估。使用RevMan 5.3进行Meta分析,结果采用平均偏差和95%置信区间:初步检索共获得 1,181 篇文章,其中六项研究符合纳入标准。这些研究共涉及 1,470 名患者,其中 1,086 人完成了随访。与早晨用药相比,睡前服用阿司匹林可显著降低收缩压和舒张压(p I 2 = 0%)。就舒张压而言,加权平均差为 1.92,同样倾向于睡前用药,异质性为 3%:这项荟萃分析涉及 1,300 多名心血管/高血压患者,与早晨用药相比,支持睡前服用阿司匹林在降低收缩压和舒张压方面的有效性。研究结果与之前的研究结果一致,但由于纳入了更多样化的患者群体,并解决了中等程度的异质性问题,因而与众不同。虽然研究结果很有希望,但还需要进一步的研究,包括更大的样本量和更长的持续时间,以便在临床上全面实施。由于该研究只关注了阿司匹林的服用时机,因此未来的研究应探讨阿司匹林与其他高血压药物同时服用对临床适应症患者的血压持续影响。
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Acetylsalicylic acid dosed at bedtime vs. dosed in the morning for circadian rhythm of blood pressure- a systematic review and meta-analysis.

Introduction: Cardiovascular disease (CVD) is a leading global cause of morbidity and mortality, with high systolic blood pressure (SBP) identified as a major risk factor. Aspirin (Acetylsalicylic acid-ASA) has been considered for CVD prevention, prompting questions about its optimal use in primary and secondary prevention and the ideal dosing time to maximize its impact on circadian blood pressure rhythms. Previous research suggests a potential benefit of bedtime aspirin dosing in reducing blood pressure, attributed to its effects on the renin-angiotensin-aldosterone system and nitric oxide production. This systematic review and meta-analysis aim to further explore the circadian effects of aspirin on blood pressure, focusing on the timing of administration.

Methods: Adhering to PRISMA guidelines, a comprehensive search of PubMed, Cochrane Library, and clinicaltrials.gov was conducted. Randomized controlled trials (RCTs) involving patients aged >18 with cardiovascular history and hypertension were included. The primary objective was to assess the impact of bedtime-dosed and morning-dosed aspirin on systolic and diastolic blood pressure. Low-dose aspirin was administered for primary or secondary prevention. The Cochrane Risk of Bias tool evaluated study quality. Meta-analyses were conducted using RevMan 5.3, with mean deviations and 95% confidence intervals employed for outcomes.

Results: Initial searches yielded 1,181 articles, with six studies meeting the inclusion criteria. These RCTs involved 1,470 patients, with 1,086 completing follow-up. Bedtime aspirin dosing demonstrated a significant reduction in both systolic and diastolic blood pressure compared to morning dosing (p < 0.05). Meta-analysis results for systolic blood pressure revealed a weighted mean difference of approximately 3.65 mmHg in favour of bedtime dosing, with low heterogeneity (I 2 = 0%). For diastolic blood pressure, the weighted mean difference was 1.92, again favouring bedtime dosing, with 3% heterogeneity.

Conclusion: This meta-analysis, involving over 1,300 cardiovascular/hypertensive patients, supports the effectiveness of bedtime aspirin in reducing systolic and diastolic blood pressure compared to morning dosing. The results align with previous findings but distinguish themselves by incorporating a more diverse patient population and addressing moderate heterogeneity. While the study's outcomes are promising, further research, including larger sample sizes and longer durations, is warranted for comprehensive clinical implementation. As the study exclusively focused on aspirin timing, future investigations should explore sustained blood pressure effects in patients with clinical indications for aspirin alongside other hypertensive medications.

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来源期刊
Frontiers in Cardiovascular Medicine
Frontiers in Cardiovascular Medicine Medicine-Cardiology and Cardiovascular Medicine
CiteScore
3.80
自引率
11.10%
发文量
3529
审稿时长
14 weeks
期刊介绍: Frontiers? Which frontiers? Where exactly are the frontiers of cardiovascular medicine? And who should be defining these frontiers? At Frontiers in Cardiovascular Medicine we believe it is worth being curious to foresee and explore beyond the current frontiers. In other words, we would like, through the articles published by our community journal Frontiers in Cardiovascular Medicine, to anticipate the future of cardiovascular medicine, and thus better prevent cardiovascular disorders and improve therapeutic options and outcomes of our patients.
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