Efecto del alcohol en la presión arterial
Information
- DOI:
- https://doi.org/10.1002/14651858.CD012787.pub2Copy DOI
- Database:
-
- Cochrane Database of Systematic Reviews
- Version published:
-
- 01 July 2020see what's new
- Type:
-
- Intervention
- Stage:
-
- Review
- Cochrane Editorial Group:
-
Cochrane Hypertension Group
- Copyright:
-
- Copyright © 2020 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
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Cited by:
Authors
Contributions of authors
James M Wright (JMW) formulated the idea, developed the basis of the protocol, and contributed to data analysis, interpretation of the final result, and editing of the final draft of the review.
Sara Tasnim (ST) and Chantel Tang (CT) drafted the protocol with help from JMW. Both ST and CT independently assessed studies for inclusion or exclusion and assessed the risk of bias of all included studies.
ST extracted data, checked data entry, conducted data analysis, interpreted study results, and drafted the final review.
CT checked data entry and contributed to drafting of the review.
Vijaya Musini (VM) contributed to data analysis, interpretation of the final result, and editing of the final draft of the review.
All review authors reviewed and approved the final version.
Sources of support
Internal sources
-
Department of Anesthesiology, Pharmacology & Therapeutics, University of BC, Canada
infrastructure
External sources
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British Columbia Ministry of Health, Canada
Therapeutics Initiative grant
Declarations of interest
Chantel Tang: none known.
Sara Tasnim: none known.
Vijaya Musini: none known.
James M Wright: none known.
Acknowledgements
We would like to acknowledge Douglas Salzwedel for designing the search strategy. We would also like to thank the Cochrane Hypertension Group members for their input.
Version history
| Published | Title | Stage | Authors | Version |
| 2020 Jul 01 | Effect of alcohol on blood pressure | Review | Sara Tasnim, Chantel Tang, Vijaya M Musini, James M Wright | |
| 2017 Sep 01 | Effect of alcohol on blood pressure | Protocol | Sara Tasnim, Chantel Tang, James M Wright | |
Differences between protocol and review
According to the published protocol, we intended to include only double‐blind RCTs in this review. Because higher doses of alcohol exert specific pharmacological effects on drinkers, we had a few double‐blind RCTs after the first screening. Considering the difficulty of masking in these types of studies, we decided to also include single‐blind and open‐label studies in the review.
Keywords
MeSH
Medical Subject Headings (MeSH) Keywords
- Alcohol Drinking;
- *Alcoholic Beverages;
- Bias;
- Blood Pressure [*drug effects];
- Central Nervous System Depressants [administration & dosage, *pharmacology];
- Cross-Over Studies;
- Ethanol [administration & dosage, *pharmacology];
- Heart Rate [*drug effects];
- Randomized Controlled Trials as Topic;
- Sex Factors;
- Time Factors;
Medical Subject Headings Check Words
Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Young Adult;
PICOs
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Funnel plot of comparison: 2 Medium‐dose alcohol vs placebo, outcome: 2.4 Heart rate.
Funnel plot of comparison: 3 High‐dose alcohol vs placebo, outcome: 3.1 Systolic blood pressure.
Funnel plot of comparison: 3 High‐dose alcohol vs placebo, outcome: 3.2 Diastolic blood pressure.
Funnel plot of comparison: 3 High‐dose alcohol vs placebo, outcome: 3.3 Mean arterial blood pressure.
Funnel plot of comparison: 3 High‐dose alcohol vs placebo, outcome: 3.4 Heart rate.
Funnel plot of comparison: 2 Medium‐dose alcohol vs placebo, outcome: 2.1 Systolic blood pressure.
Funnel plot of comparison: 2 Medium‐dose alcohol vs placebo, outcome: 2.2 Diastolic blood pressure.
Funnel plot of comparison: 2 Medium‐dose alcohol vs placebo, outcome: 2.3 Mean arterial blood pressure.
Comparison 1: Low‐dose alcohol vs placebo, Outcome 1: Systolic blood pressure
Comparison 1: Low‐dose alcohol vs placebo, Outcome 2: Diastolic blood pressure
Comparison 1: Low‐dose alcohol vs placebo, Outcome 3: Mean arterial blood pressure
Comparison 1: Low‐dose alcohol vs placebo, Outcome 4: Heart rate
Comparison 2: Medium‐dose alcohol vs placebo, Outcome 1: Systolic blood pressure
Comparison 2: Medium‐dose alcohol vs placebo, Outcome 2: Diastolic blood pressure
Comparison 2: Medium‐dose alcohol vs placebo, Outcome 3: Mean arterial blood pressure
Comparison 2: Medium‐dose alcohol vs placebo, Outcome 4: Heart rate
Comparison 3: High‐dose alcohol vs placebo, Outcome 1: Systolic blood pressure
Comparison 3: High‐dose alcohol vs placebo, Outcome 2: Diastolic blood pressure
Comparison 3: High‐dose alcohol vs placebo, Outcome 3: Mean arterial blood pressure
Comparison 3: High‐dose alcohol vs placebo, Outcome 4: Heart rate
| Effect of high‐dose alcohol compared to placebo | ||||
| Patient or population: adult participants | ||||
| Outcomes | Participants | Certainty of the evidence (GRADE) | Mean difference of high‐dose alcohol compared to placebo* (95% CI) | |
|---|---|---|---|---|
| Systolic blood pressure ‐ ≤ 6 hours | 418 | ⊕⊕⊕⊝ | ‐3.5 mmHg [‐6 to ‐0.5] | |
| Systolic blood pressure ‐ 7 to 12 hours | 54 | ⊕⊕⊕⊝ | ‐3.7 mmHg [‐6.9 to ‐0.5] | |
| Systolic blood pressure ‐ ≥ 13 hours | 154 | ⊕⊕⊕⊝ | 3.7 mmHg [2.3 to 5] | |
| Diastolic blood pressure ‐ ≤ 6 hours | 350 | ⊕⊕⊝⊝ | ‐1.9 mmHg [‐3.9 to 0.04] | |
| Diastolic blood pressure ‐ 7 to 12 hours | 54 | ⊕⊕⊝⊝ | ‐1.6 mmHg [‐4.1 to 0.9] | |
| Diastolic blood pressure ‐ ≥ 13 hours | 154 | ⊕⊕⊕⊝ | 2.4 mmHg [0.3 to 4.5] | |
| Heart rate ‐ ≤ 6 hours | 495 | ⊕⊕⊕⊝ | 5.5 bpm [4.3 to 6.7] | |
| Heart rate ‐ 7 to 12 hours | 144 | ⊕⊕⊕⊝ | 6.2 bpm [3 to 9.3] | |
| Heart rate ‐ ≥ 13 hours | 244 | ⊕⊕⊕⊝ | 2.7 bpm [0.8 to 4.6] | |
| * The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RCT: randomised controlled trial. | ||||
| GRADE Working Group grades of evidence. | ||||
| aUnclear risk of selection bias and attrition bias in more than one study. b95% confidence interval around the best effect estimate includes both negligible effect and appreciable benefit. | ||||
| Effect of medium‐dose alcohol compared to placebo | |||
| Patient or population: adult participants | |||
| Outcomes | Participants | Certainty of the evidence (GRADE) | Mean difference of medium‐dose alcohol compared to placebo* (95% CI) |
|---|---|---|---|
| Systolic blood pressure ‐ ≤ 6 hours | 149 | ⊕⊕⊕⊝ | ‐5.63 mmHg [‐8.3 to ‐3] |
| Systolic blood pressure ‐ 7 to 12 hours | 54 | ⊕⊕⊝⊝ | ‐3.2 mmHg [‐8.4 to 2] |
| Systolic blood pressure ‐ ≥ 13 hours | 66 | ⊕⊕⊝⊝ | 0.6 mmHg [‐3.9 to 5.2] |
| Diastolic blood pressure ‐ ≤ 6 hours | 149 | ⊕⊕⊕⊝ | ‐4 mmHg [‐6 to ‐2] |
| Diastolic blood pressure ‐ 7 to 12 hours | 54 | ⊕⊕⊝⊝ | ‐1.2 mmHg [‐4.3 to 1.9] |
| Diastolic blood pressure ‐ ≥ 13 hours | 66 | ⊕⊕⊕⊝ | 1.8 mmHg [‐0.9 to 4.5] |
| Heart rate ‐ ≤ 6 hours | 181 | ⊕⊕⊕⊝ | 4.6 bpm [3.1 to 6.1] |
| Heart rate ‐ 7 to 12 hours | 54 | ⊕⊕⊝⊝ | 1.2 bpm [‐1.9 to 4.3] |
| Heart rate ‐ > 13 hours | 36 | ⊕⊕⊝⊝ | 1.4 bpm [‐2.1 to 4.9] |
| * The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | |||
| GRADE Working Group grades of evidence. | |||
| aUnclear risk of selection bias in more than one study. b95% confidence interval around the effect estimate includes both appreciable benefit and appreciable harm. cUnclear risk of selection bias and attrition bias in more than one study. | |||
| Effect of low‐dose alcohol compared to placebo | |||
| Patient or population: adult participants | |||
| Outcomes | Participants | Certainty of the evidence (GRADE) | Mean difference of low‐dose alcohol compared to placebo* (95% CI) |
|---|---|---|---|
| Systolic blood pressure ‐ ≤ 6 hours | 28 | ⊕⊕⊝⊝ | ‐1.9 mmHg [‐8.4 to 5.4] |
| Diastolic blood pressure ‐ ≤ 6 hours | 28 | ⊕⊕⊝⊝ | ‐1.5 mmHg [‐6.9 to 4] |
| Heart rate ‐ ≤ 6 hours | 28 | ⊕⊕⊕⊝ | 5.1 bpm [1.88 higher to 8.24] |
| * The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | |||
| GRADE Working Group grades of evidence. | |||
| aUnclear risk of selection bias. b95% confidence interval around the best effect estimate includes both negligible effect and appreciable benefit. | |||
| Study ID | Randomised participants, N | Mean age | Mean body | Health condition | Reported dose of alcohol | Duration of intervention | Baseline SBP | Baseline DBP | Baseline HR |
| 12 | 31 (younger than 40 years old) | Not reported | Healthy, normotensive non‐smokers | 31.25 g | 10 minutes | 121 (6) | 79 (4) | 61 (7) | |
| 24 | 56 (20 to 65) | Not | Healthy | 41 g | 30 minutes | 115 (11) | 72 (6) | 62 (7) | |
| 100 | 20.7 (18 to 25) | Not | Healthy non‐smokers | 60 g | 30 minutes | 114.2 | 64.8 | 72.43 (10.9) | |
| 70 | 20.7 (18 to 25) | Not | Healthy | 60 g | 30 minutes | Not reported | Not reported | 75 (10) | |
| 72 | 21.5 | Not | Healthy | 0.90 mL/kg for men 0.78 mL/kg for women | 15 minutes | 116.9 (13.5) | Not reported | 66.9 (9.9) | |
| 20 | 19 to 32 | Not | Healthy, normotensive non‐smokers | Target to achieve blood level of 0.05% | Not reported (mentioned that fairly | 118 (12.88) | 62.25 (5.1) | 63.13 (7.1) | |
| 17 | 35 (21 to 46) | Not | Type 1 diabetes | 0.35 mg/kg BW | Not reported | 116.2 (18.7) | 66.8 (8.2) | 70 (12) | |
| 40 | 19 to 25 years | 81.35 | Healthy | 0.5 g/kg | 5 minutes | 114.1 | 72.6 | 63.5 | |
| 14 | 22.1 (18 to 29) | Not | Regular user of MDMA, | Target blood alcohol level 0.6%, equivalent of 2 to 3 alcoholic beverages. | 3 hours to maintain | Not reported | Not reported | 66 | |
| 18 | 34.2 (25 to 53) | 70.2 | Healthy | 30 g | 10 hours | 110.3 (12) | 80 (8) | 75.5 (11.5) | |
| 10 | 22 (20 to 25) | Not | Healthy | 0.3 g/kg | 5 minutes | Not reported | Not reported | 68 | |
| 13 | 55 (43 to 65) | Not | Hypertensive and centrally | 23 g | 15 minutes | 130 | 83 | 72 (8.72) | |
| 24 | 44 | Not | 13 hypertensive and 11 | 1 g/kg | 20 minutes | Hypertensive: 150 Normotensive: 136 (13.2) | Hypertensive: 91 (14.4) Normotensive: 76 (10) | Hypertensive: 72 (7.2) Normotensive: 70 (10) | |
| 15 | 52.4 | Not | Coronary artery disease | 30 g | Not reported | 109.8 (9.2) | 80.7 (10.8) | 67.1 (13.1) | |
| 16 | 28.5 | 77.5 | Healthy non‐smokers | 20 g | 15 minutes | 115.4 (6.2) | 68.5 (5.4) | 60 (8.1) | |
| 13 | 55.2 (22 to 70) | 65.2 | Mild to moderate essential | 51 g | Not reported | 159 (18.8) | 91.3 (12) | 61.5 | |
| 10 | 54 (32 to 67) | 70 (60 to 78) | Mild essential hypertension | 55.3 g (1 mL/kg BW) | 60 minutes | 147 | 91 | 65 | |
| 15 | 20 to 35 | 76 | Healthy | 10 mL/kg BW | 30 minutes | 127 (11) | 80 (9.5) | Not reported | |
| 21 | 56.5 (33 to 73) | Not | Essential hypertension | 1 mL/kg BW | 30 minutes | 146 (18.33) | 89 (9.2) | 59 (9.2) | |
| 8 | 21 to 40 | 70 | Healthy, normotensive non‐smokers | 56 g (0.8 g/kg of BW) | 10 minutes | 93.3 (10) | 67 (8) | Not reported | |
| 24 | 23.3 | 62.9 | Healthy | 0.4 g/kg | 5 minutes | Not reported | Not reported | 69 (9.8) | |
| 10 | 31 (22 to 51) | 68.1 | Healthy | 34 g (0.5 g/kg BW) | 10 minutes | 122 | 70 | 62 (6.3) | |
| 19 | 26 | Not | Healthy | 1 g/kg BW | 30 minutes | 111 (11.2) | 61 (7.5) | 57 (7.5) | |
| 11 | 21.1 (20 to 22) | 62.6 | Healthy non‐smokers | 11 g and 19.25 g | 5 minutes | 123 (6.63) | 71 (6.63) | 59 (9.94) | |
| 16 | 22 (20 to 30) | 77 | Healthy, normotensive | 0.75 g/kg | 15 minutes | 122.5 (11) | 72.5 (9) | 63.2 (8) | |
| 40 | 22.2 (19 to 30) | Not | Healthy | 60 g | 1 hour | 124.2 (10.7) | 76.2 (9.4) | 70.5 (12.6) | |
| 20 | 39 to 68 | Not | Coronary artery disease and Patients were taking | 1.25 g/kg | 1 hour | 132 (16) | Not reported | 69.5 | |
| 10 | 18 to 31 | 56 to 101 | Healthy | 1.3 g/kg | 1 hour | 115.5 | 67 | 70.5 | |
| 8 | 81 (70 to 96) | 68.4 | Normotensive | 0.5 g/kg | 15 minutes | 130 (18.3) | 77.5 (15.5) | 57 (7.5) | |
| 16 | 26 | Not | Healthy | 1 g/kg | 30 minutes | Not reported | Not reported | 59 (8) | |
| 13 | 59 (48 to 70) | 86 | Coronary artery disease | 0.52 g/kg | 20 minutes | 135 (11) | 82 (7) | 55 (11) | |
| 48 | 20.9 (19 to 23) | Not | Healthy | 1 g/kg | 20 minutes | 115.5 (10.2) | 70.4 (9.1) | 69.4 (12.10) | |
| BAC: blood alcohol concentration. | |||||||||
| Study ID | Reason for contact | Contacted? (Yes/No) | Response? (Yes/No) |
| Method of allocation concealment used in RCT was not mentioned | No Comment ‐ contact information cannot be found | NA | |
| Method of allocation concealment used in RCT was not mentioned | Yes | No | |
| Method of allocation concealment used in RCT was not mentioned | Yes | No | |
| Method of allocation concealment used in RCT was not mentioned | Yes | Yes | |
| Methods of randomisation and allocation concealment used in RCT were not mentioned | No Comment ‐ contact information cannot be found | NA | |
| Method of allocation concealment used in RCT was not mentioned | Yes | No | |
| Methods of randomisation and allocation concealment, blinding of participants and personnel, and blinding of outcome assessment used in RCT were not mentioned | Yes | No | |
| Methods of randomisation and allocation concealment used in RCT were not mentioned | Yes | No | |
| Methods of randomisation and allocation concealment used in RCT were not mentioned | Yes | No | |
| Methods of randomisation and allocation concealment used in RCT were not mentioned | Yes | Yes | |
| Methods of allocation concealment used in RCT was not mentioned | Yes | Yes | |
| Methods of randomisation and allocation concealment, blinding of participants and personnel, and blinding of outcome assessment used in RCT were not mentioned | Yes | No | |
| Methods of randomisation and allocation concealment used in RCT were not mentioned | Yes | No | |
| Methods of randomisation and allocation concealment used in RCT were not mentioned | Yes Comment ‐ contact information cannot be found in the study. However, we used contact information provided in Kawano 2000 | No | |
| Methods of randomisation and allocation concealment used in RCT were not mentioned | Yes | No | |
| Methods of randomisation and allocation concealment used in RCT were not mentioned | No Comment ‐ contact information cannot be found | NA | |
| Methods of randomisation and allocation concealment, blinding of participants and personnel, and blinding of outcome assessment used in RCT were not mentioned | Yes | No | |
| Method of allocation concealment used in RCT was not mentioned | Yes | No | |
| Methods of randomisation and allocation concealment used in RCT were not mentioned | No Comment ‐ contact information cannot be found | NA | |
| Methods of randomisation and allocation concealment used in RCT were not mentioned | Yes | No | |
| Methods of randomisation and allocation concealment used in RCT were not mentioned | Yes | No | |
| Methods of randomisation and allocation concealment and blinding of outcome assessor used in RCT were not mentioned | No Comment ‐ contact information cannot be found | NA | |
| Methods of randomisation and allocation concealment used in RCT were not mentioned | No Comment ‐ contact information cannot be found | NA | |
| Methods of randomisation and allocation concealment and blinding of participants and personnel used in RCT were not mentioned | Yes | Yes | |
| Methods of randomisation and allocation concealment used in RCT were not mentioned | No Comment ‐ contact information cannot be found | NA | |
| Methods of randomisation and allocation concealment used in RCT were not mentioned | No Comment ‐ contact information cannot be found | NA | |
| Methods of randomisation and allocation concealment used in RCT were not mentioned | No Comment ‐ contact information cannot be found | NA | |
| Methods of randomisation and allocation concealment used in RCT were not mentioned | No Comment ‐ contact information cannot be found | NA | |
| Methods of randomisation and allocation concealment used in RCT were not mentioned | No Comment ‐ contact information cannot be found | NA | |
| NA: not applicable. | |||
| Outcomes or subgroup | Mean difference, IV, fixed‐effect model, 95% CI | Mean difference, IV, random‐effects model, 95% CI |
| 2.1 SBP (≤ 6 hours) | ‐5.63 [‐8.25, ‐3.02] Heterogeneity: Chi² = 24.51, df = 9 (P = 0.004); I² = 63% Test for overall effect: Z = 4.22 (P < 0.0001) | ‐6.15 [‐10.55, ‐1.75] Heterogeneity: Chi² = 24.51, df = 9 (P = 0.004); I² = 63% Test for overall effect: Z = 2.74 (P = 0.006) |
| 2.2 DBP (≤ 6 hours) | ‐4.01 [‐6.02, ‐2.00] Heterogeneity: Chi² = 21.81, df = 9 (P = 0.009); I² = 59% Test for overall effect: Z = 3.91 (P < 0.0001) | ‐3.76 [‐7.02, ‐0.50] Heterogeneity: Chi² = 21.81, df = 9 (P = 0.009); I² = 59% Test for overall effect: Z = 2.26 (P = 0.02) |
| 2.3 MAP (≤ 6 hours) | ‐2.17 [‐3.68, ‐0.65] Heterogeneity: Chi² = 38.36, df = 12 (P = 0.0001); I² = 69% Test for overall effect: Z = 2.80 (P = 0.005) | ‐2.92 [‐5.76, ‐0.07] Heterogeneity: Chi² = 38.36, df = 12 (P = 0.0001); I² = 69% Test for overall effect: Z = 2.01 (P = 0.04) |
| CI: confidence interval. | ||
| Outcomes or subgroups | Blinded studies, mean difference, IV, fixed‐effect model, 95% CI | Unblinded, mean difference, IV, fixed‐effect model, 95% CI |
| 2.1 SBP (< 6 hours) | ‐4.56 [‐8.39, ‐0.73] Heterogeneity: Chi² = 2.14, df = 3 (P = 0.54); I² = 0% Test for overall effect: Z = 2.33 (P = 0.02) | ‐6.57 [‐10.15, ‐3.00] Heterogeneity: Chi² = 21.80, df = 5 (P = 0.0006); I² = 77% Test for overall effect: Z = 3.60 (P = 0.0003) |
| 2.2 DBP (< 6 hours) | ‐1.50 [‐4.89, 1.89] Heterogeneity: Chi² = 1.99, df = 3 (P = 0.57); I² = 0% Test for overall effect: Z = 0.86 (P = 0.39) | ‐5.37 [‐7.86, ‐2.87] Heterogeneity: Chi² = 16.57, df = 5 (P = 0.005); I² = 70% Test for overall effect: Z = 4.22 (P < 0.0001) |
| 2.3 MAP (< 6 hours) | ‐0.11 [‐3.39, 3.18] Heterogeneity: Chi² = 8.24, df = 4 (P = 0.08); I² = 51% Test for overall effect: Z = 0.06 (P = 0.95) | ‐4.93 [‐8.83, ‐1.02] Heterogeneity: Chi² = 21.61, df = 7 (P = 0.003); I² = 68% Test for overall effect: Z = 2.47 (P = 0.01) |
| 2.4 HR (< 6 hours) | 4.35 [2.31, 6.40] Heterogeneity: Chi² = 2.33, df = 3 (P = 0.51); I² = 0% Test for overall effect: Z = 4.17 (P < 0.0001) | 4.92 [2.77, 7.08] Heterogeneity: Chi² = 7.37, df = 7 (P = 0.39); I² = 5% Test for overall effect: Z = 4.48 (P < 0.00001) |
| 3.1 SBP (< 6 hours) | ‐3.80 [‐8.03, 0.43] Heterogeneity: Chi² = 21.01, df = 7 (P = 0.004); I² = 67% Test for overall effect: Z = 1.76 (P = 0.08) | ‐2.84 [‐5.53, ‐0.14] Heterogeneity: Chi² = 6.04, df = 7 (P = 0.54); I² = 0% Test for overall effect: Z = 2.06 (P = 0.04) |
| 3.2 DBP (< 6 hours) | ‐1.88 [‐4.73, 0.97] Heterogeneity: Tau² = 6.68; Chi² = 11.57, df = 6 (P = 0.07); I² = 48% Test for overall effect: Z = 1.29 (P = 0.20) | ‐1.99 [‐4.89, 0.90] Heterogeneity: Tau² = 3.87; Chi² = 8.16, df = 6 (P = 0.23); I² = 26% Test for overall effect: Z = 1.35 (P = 0.18) |
| 3.3 MAP (< 6 hours) | ‐1.62 [‐3.98, 0.74] Heterogeneity: Chi² = 10.45, df = 8 (P = 0.23); I² = 23% Test for overall effect: Z = 1.35 (P = 0.18) | ‐1.44 [‐4.46, 1.57] Heterogeneity: Chi² = 11.54, df = 7 (P = 0.12); I² = 39% Test for overall effect: Z = 0.94 (P = 0.35) |
| 3.4 HR (< 6 hours) | 4.82 [3.01, 6.63] Heterogeneity: Chi² = 5.79, df = 8 (P = 0.67); I² = 0% Test for overall effect: Z = 5.22 (P < 0.00001) | 6.62 [3.21, 10.03] Heterogeneity: Chi² = 16.68, df = 7 (P = 0.02); I² = 58% Test for overall effect: Z = 3.81 (P = 0.0001) |
| CI: confidence interval. | ||
| Analysis | Older participants (mean age ≥ 50), mean difference, IV, fixed‐effect model, 95% CI | Younger participants (mean age < 50), mean difference, IV, fixed‐effect model, 95% CI |
|---|---|---|
| 2.1 SBP (< 6 hours) | ‐11.25 [‐15.63, ‐6.87] Test for overall effect: Z = 5.04 (P < 0.00001); df = 3 (P = 0.03); I² = 66% | ‐2.52 [‐5.78, 0.74] Test for overall effect: Z = 1.52 (P = 0.13); df = 5 (P = 0.31); I² = 16% |
| 2.2 DBP (<6 hours) | ‐7.82 [‐11.08, ‐4.57] Test for overall effect: Z = 4.71 (P < 0.00001); df = 3 (P = 0.008); I² = 74% | ‐1.66 [‐4.22, 0.89] Test for overall effect: Z = 1.28 (P = 0.20); df = 5 (P = 0.91); I² = 0% |
| 3.1 SBP (<6 hours) | ‐6.71 [‐11.23, ‐2.18] | ‐3.04 [‐4.87, ‐1.20]; |
| 3.2 DBP (<6 hours) | ‐4.30 [‐7.32, ‐1.27] | ‐1.67 [‐3.33, ‐0.01] |
| CI: confidence interval. | ||
| Outcomes | Very high dose (≥ 60 g) Mean difference, IV, fixed‐effect model, 95% CI | Lower high dose (31 to 59 g) Mean difference, IV, fixed‐effect model, 95% CI |
|---|---|---|
| 3.1. SBP | ‐5.12 [‐7.32, ‐2.92] | ‐1.20 [‐3.90, 1.49] |
| 3.2. DBP | ‐3.21 [‐5.49, ‐0.92] | ‐1.65 [‐3.53, 0.23] |
| 3.3. MAP | 2.17 [‐4.09, ‐0.25] | ‐0.47 [‐2.83, 1.90] |
| 3.4. HR | 5.43 [3.76, 7.11] | 6.09 [3.67, 8.51] |
| CI: confidence interval. | ||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1.1 Systolic blood pressure Show forest plot | 2 | Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 1.1.1 ≤ 6 hours | 2 | 56 | Mean Difference (IV, Fixed, 95% CI) | ‐1.48 [‐8.38, 5.42] |
| 1.2 Diastolic blood pressure Show forest plot | 2 | Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 1.2.1 ≤ 6 hours | 2 | 56 | Mean Difference (IV, Fixed, 95% CI) | ‐1.46 [‐6.91, 3.99] |
| 1.3 Mean arterial blood pressure Show forest plot | 2 | Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 1.3.1 ≤ 6 hours | 2 | 56 | Mean Difference (IV, Fixed, 95% CI) | ‐1.45 [‐4.55, 1.65] |
| 1.4 Heart rate Show forest plot | 2 | Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 1.4.1 ≤ 6 hours | 2 | 56 | Mean Difference (IV, Fixed, 95% CI) | 5.06 [1.88, 8.24] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 2.1 Systolic blood pressure Show forest plot | 9 | Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 2.1.1 ≤ 6 hours | 9 | 260 | Mean Difference (IV, Fixed, 95% CI) | ‐5.63 [‐8.25, ‐3.02] |
| 2.1.2 7 to 12 hours | 4 | 108 | Mean Difference (IV, Fixed, 95% CI) | ‐3.22 [‐8.37, 1.93] |
| 2.1.3 ≥ 13 hours | 4 | 112 | Mean Difference (IV, Fixed, 95% CI) | 0.64 [‐3.90, 5.18] |
| 2.2 Diastolic blood pressure Show forest plot | 9 | Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 2.2.1 ≤ 6 hours | 9 | 260 | Mean Difference (IV, Fixed, 95% CI) | ‐4.01 [‐6.02, ‐2.00] |
| 2.2.2 7 to 12 hours | 4 | 108 | Mean Difference (IV, Fixed, 95% CI) | ‐1.19 [‐4.29, 1.90] |
| 2.2.3 ≥ 13 hours | 4 | 112 | Mean Difference (IV, Fixed, 95% CI) | 1.78 [‐0.95, 4.51] |
| 2.3 Mean arterial blood pressure Show forest plot | 12 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 2.3.1 ≤ 6 hours | 12 | 360 | Mean Difference (IV, Random, 95% CI) | ‐2.92 [‐5.76, ‐0.07] |
| 2.3.2 7 to 12 hours | 4 | 108 | Mean Difference (IV, Random, 95% CI) | ‐2.11 [‐4.69, 0.48] |
| 2.3.3 ≥ 13 hours | 4 | 112 | Mean Difference (IV, Random, 95% CI) | 1.43 [‐1.18, 4.04] |
| 2.4 Heart rate Show forest plot | 12 | Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 2.4.1 ≤ 6 hours | 12 | 344 | Mean Difference (IV, Fixed, 95% CI) | 4.62 [3.14, 6.11] |
| 2.4.2 7 to 12 hours | 4 | 108 | Mean Difference (IV, Fixed, 95% CI) | 1.22 [‐1.88, 4.32] |
| 2.4.3 ≥ 13 hours | 3 | 72 | Mean Difference (IV, Fixed, 95% CI) | 1.37 [‐2.12, 4.86] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 3.1 Systolic blood pressure Show forest plot | 16 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 3.1.1 ≤ 6 hours | 16 | 620 | Mean Difference (IV, Random, 95% CI) | ‐3.49 [‐6.03, ‐0.95] |
| 3.1.2 7 to 12 hours | 3 | 88 | Mean Difference (IV, Random, 95% CI) | ‐3.72 [‐6.97, ‐0.48] |
| 3.1.3 ≥ 13 hours | 4 | 188 | Mean Difference (IV, Random, 95% CI) | 3.69 [2.33, 5.05] |
| 3.2 Diastolic blood pressure Show forest plot | 14 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 3.2.1 ≤ 6 hours | 14 | 532 | Mean Difference (IV, Random, 95% CI) | ‐1.91 [‐3.86, 0.04] |
| 3.2.2 7 to 12 hours | 3 | 88 | Mean Difference (IV, Random, 95% CI) | ‐1.71 [‐4.59, 1.17] |
| 3.2.3 ≥ 13 hours | 4 | 188 | Mean Difference (IV, Random, 95% CI) | 2.37 [0.25, 4.49] |
| 3.3 Mean arterial blood pressure Show forest plot | 17 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 3.3.1 ≤ 6 hours | 17 | 640 | Mean Difference (IV, Random, 95% CI) | ‐1.53 [‐3.34, 0.28] |
| 3.3.2 7 to 12 hours | 3 | 88 | Mean Difference (IV, Random, 95% CI) | ‐2.47 [‐5.69, 0.75] |
| 3.3.3 ≥ 13 hours | 4 | 188 | Mean Difference (IV, Random, 95% CI) | 2.96 [0.35, 5.58] |
| 3.4 Heart rate Show forest plot | 17 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 3.4.1 ≤ 6 hours | 17 | 704 | Mean Difference (IV, Random, 95% CI) | 5.75 [3.99, 7.51] |
| 3.4.2 7 to 12 hours | 5 | 198 | Mean Difference (IV, Random, 95% CI) | 6.16 [3.04, 9.28] |
| 3.4.3 ≥ 13 hours | 6 | 298 | Mean Difference (IV, Random, 95% CI) | 2.70 [0.80, 4.60] |
