活血散风针刺法对脑梗死合并高血压患者血压干预效果的真实世界研究

背景高血压作为最常见的慢性病，是心脑血管疾病及血管事件的主要高危因素，既往研究发现针刺具有降压作用，但目前缺乏真实世界研究的针刺降压证据。目的本研究旨在评价活血散风针刺法对脑梗死合并高血压住院患者的血压控制效果。方法选取于2014年1月至2020年4月期间就诊于天津中医药大学第一附属医院针灸科病房的符合纳入、排除标准的脑梗死合并高血压患者10 781例，根据住院期间是否使用活血散风针刺法分为基础治疗组（n=10 424）和活血散风组（n=357），采用倾向性评分匹配（PSM）得到组间协变量均衡的新样本，通过线性混合效应模型比较新样本活血散风组与基础治疗组患者住院的日均血压和清晨血压，以评价活血散风针刺法控制血压的效果。结果PSM前两组患者性别、年龄、是否有冠心病、是否有糖尿病、是否有心房颤动及同型半胱氨酸（HCY）、总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白（LDL）、肌酐（Cr）水平比较，差异无统计学意义（P>0.05），基础治疗组高密度脂蛋白（HDL）、尿素（Ur）水平高于活血散风组（P<0.05）。PSM后两组患者的性别、年龄、是否有冠心病、是否有糖尿病、是否有心房颤动及HCY、TC、TG、HDL、LDL、Cr、Ur水平比较，差异无统计意义（P>0.05）。线性混合效应模型结果显示，活血散风组平均收缩压低于基础治疗组（P=0.002）；活血散风组舒张压平均水平与基础治疗组比较，差异无统计学意义（P=0.083）；治疗方式与入院时间之间无交互作用（P=0.532，P=0.775）。混合效应模型结果显示，活血散风组清晨收缩压低于基础治疗组（P=0.012）；活血散风组清晨舒张压与基础治疗组比较，差异无统计学意义（P=0.539）；治疗方式与入院时间之间无交互作用（P=0.974，P=0.985）。结论活血散风针刺法可进一步控制脑梗死合并高血压住院患者的日均收缩压及清晨收缩压水平。

A Real-world Research of Huoxue Sanfeng Acupuncture Intervention on Blood Pressure in Patients with Cerebral Infarction and Hypertension

Background As the most common chronic disease,hypertension is an important high-risk factor for cardiovascular and cerebrovascular diseases and vascular events.Previous studies have found that acupuncture has the effect of lowering blood pressure,but there is currently a lack of real-world research evidence for acupuncture to lower blood pressure.Objective To evaluate the blood pressure control effect of Huoxue Sanfeng acupuncture on hospitalized patients with cerebral infarction and hypertension in the real world.Methods Patients with cerebral infarction and hypertension meeting the inclusion and exclusion criteria in the acupuncture ward of First Teaching Hospital of Tianjin University of Traditional Chinese Medicine from January 2014 to April 2020 were selected.There were 10781 patiens who met the inclusion and exclusion criteria.According to whether the Huoxue Sanfeng acupuncture method was applied during hospitalization,the patients were divided into basic treatment group(n=10424)and Huoxue Sanfeng group(n=357).The propensity score matching(PSM)was used to obtain a new sample with balanced covariates between groups,and the linear mixed effects model was used to compare the average daily blood pressure and morning blood pressure of the two groups in the new sample,which was used to evaluate the effect of Huoxue Sanfeng acupuncture in controlling blood pressure.Results There was no statistically significant difference in gender,age,coronary heart disease,diabetes,atrial fibrillation,the levels of HCY,TC,TG,LDL,and Cr levels before matching(P>0.05),while the levels of HDL and Ur in basic treatment group were higher than those in the Huoxue Sanfeng group(P<0.05).After matching,the differences in gender,age,coronary heart disease,diabetes,atrial fibrillation,the levels of HCY,TC,TG,HDL,LDL,Cr,Ur were not statistically significant difference between the two groups(P>0.05).The results of the linear mixed effect model showed that the average systolic blood pressure in the Huoxue Sanfeng group was lower than the basic treatment group(P=0.002);the average level of diastolic blood pressure in the Huoxue Sanfenggroup and the basic treatment group was not statistically significant difference(P=0.083);there was no interaction between treatment methods and hospital admission time(P=0.532,P=0.775).The results of the mixed effect model showed that after the intervention of different treatments,the systolic blood pressure in theHuoxue Sanfenggroup was lower than the basic treatment group in the morning(P=0.012);the morning diastolic blood pressure of the Huoxue Sanfenggroup and the basic treatment group was not statistically significant difference(P=0.539);there was no interaction between the treatment method and hospital admission time(P=0.974,P=0.985).Conclusion Huoxue Sanfeng acupuncture can further control the daily average systolic blood pressure and early morning systolic blood pressure in hospitalized patients with cerebral infarction and hypertension.