Abstract：
Hypertension is an important risk factor for cardiovascular disease (CVD). Interventions with dietitians can help modify dietary intake and reduce hypertension risk.
We aimed to examine the following research question: In adults with prehypertension or hypertension, what is the effect of medical nutrition therapy (MNT) provided by a dietitian on blood pressure (BP), CVD risk and events, and anthropometrics compared with standard care or no intervention?
MEDLINE, CINAHL, and Cochrane Central databases were searched for randomized controlled trials (RCTs) published in peer-reviewed journals from 1985-2022. Risk of bias was assessed using version 2 of the Cochrane tool for RCTs. Meta-analyses were conducted using the DerSimonian-Laird random-effects model. Certainty of evidence (COE) was assessed for each outcome using the Grading of Recommendations, Assessment and Evaluation method.
Forty articles representing 31 RCTs were included and analyzed. MNT provided by a dietitian may reduce systolic [mean difference (MD): -3.63 mmHg; 95% confidence interval (CI): -4.35, -2.91 mmHg] and diastolic (MD: -2.02 mmHg; 95% CI: -2.56, -1.49 mmHg) BP (P < 0.001) and body weight (MD: -1.84 kg; 95% CI: -2.72, -0.96 kg; P < 0.001) and improve antihypertensive medication usage, relative risk of stroke (MD: 0.34; 95% CI: 0.14, 0.81; P = 0.02), and CVD risk score [standardized mean difference (SMD): -0.20; 95% CI: -0.30, -0.09; P < 0.001] compared with control participants, and COE was moderate. Additionally, MNT may reduce arterial stiffness (SMD: -0.45; 95% CI: -0.71, -0.19; P = 0.008) and waist circumference (SMD: -1.18 cm; 95% CI: -2.00, -0.36; P = 0.04), and COE was low. There was no significant difference in risk of myocardial infarction between groups. Dietitian interventions reduced BP and related cardiovascular outcomes for adults with prehypertension or hypertension.
Dietitians play a critical role in improving cardiometabolic risk factors for adults with elevated BP; thus, improved payment for and access to MNT services has the potential to significantly impact public health. This review was registered at PROSPERO as CRD42022351693.
We aimed to examine the following research question: In adults with prehypertension or hypertension, what is the effect of medical nutrition therapy (MNT) provided by a dietitian on blood pressure (BP), CVD risk and events, and anthropometrics compared with standard care or no intervention?
MEDLINE, CINAHL, and Cochrane Central databases were searched for randomized controlled trials (RCTs) published in peer-reviewed journals from 1985-2022. Risk of bias was assessed using version 2 of the Cochrane tool for RCTs. Meta-analyses were conducted using the DerSimonian-Laird random-effects model. Certainty of evidence (COE) was assessed for each outcome using the Grading of Recommendations, Assessment and Evaluation method.
Forty articles representing 31 RCTs were included and analyzed. MNT provided by a dietitian may reduce systolic [mean difference (MD): -3.63 mmHg; 95% confidence interval (CI): -4.35, -2.91 mmHg] and diastolic (MD: -2.02 mmHg; 95% CI: -2.56, -1.49 mmHg) BP (P < 0.001) and body weight (MD: -1.84 kg; 95% CI: -2.72, -0.96 kg; P < 0.001) and improve antihypertensive medication usage, relative risk of stroke (MD: 0.34; 95% CI: 0.14, 0.81; P = 0.02), and CVD risk score [standardized mean difference (SMD): -0.20; 95% CI: -0.30, -0.09; P < 0.001] compared with control participants, and COE was moderate. Additionally, MNT may reduce arterial stiffness (SMD: -0.45; 95% CI: -0.71, -0.19; P = 0.008) and waist circumference (SMD: -1.18 cm; 95% CI: -2.00, -0.36; P = 0.04), and COE was low. There was no significant difference in risk of myocardial infarction between groups. Dietitian interventions reduced BP and related cardiovascular outcomes for adults with prehypertension or hypertension.
Dietitians play a critical role in improving cardiometabolic risk factors for adults with elevated BP; thus, improved payment for and access to MNT services has the potential to significantly impact public health. This review was registered at PROSPERO as CRD42022351693.
摘要：
背景：高血压是心血管疾病的重要危险因素。与营养师的干预可以帮助改变饮食摄入量并降低高血压风险。
目的：为了检查研究问题：在患有高血压前期或高血压的成年人中，营养师提供的医学营养疗法（MNT）对血压（BP）的影响是什么，与标准护理或无干预相比，心血管风险和事件以及人体测量？
方法：MEDLINE，在CINAHL和CochraneCentral数据库中搜索了1985-2022年发表在同行评审期刊上的随机对照试验（RCT）。使用2版CochraneRCT工具评估偏倚风险(RoB)。使用DerSimonian-Laird随机效应模型进行Meta分析。使用建议分级评估每个结果的证据确定性(COE)，评估,和评估(等级)方法。
结果：纳入并分析了代表31项随机对照试验的40篇文章。营养师提供的MNT可能会降低收缩压[平均差（MD）：-3.63mmHg（95％置信区间（CI）：-4.35，-2.91）]和舒张压[-2.02mmHg（-2.56，-1.49）]BP（p<0.001）和体重[-1.84kg（-2.72，-0.96），p<0.001],改善抗高血压药物的使用，中风的相对风险[0.34（0.14，0.81），p=0.02]和CVD风险评分[标准化平均差（SMD）：-0.20（-0.30，-0.09），p<0.001]与对照参与者相比，COE适中。此外,MNT可以降低动脉僵硬度[SMD：-0.45（-0.71，-0.19），p=0.008]和腰围[-1.18cm(-2.00,-0.36),p=0.04]，COE很低。两组之间的心肌梗死风险没有显着差异。营养师干预降低了高血压前期或高血压成人的血压和相关心血管结局。
结论：营养师在改善成人血压升高的心脏代谢危险因素方面发挥着关键作用；因此，改善MNT服务的支付和获取有可能对公共卫生产生重大影响。
■此系统评价已在国际系统评价前瞻性注册簿中注册：PROSPERO#CRD42022351693（https://www.crd.约克。AC.uk/prospro/display_record.php?ID=CRD42022351693)。
目的：为了检查研究问题：在患有高血压前期或高血压的成年人中，营养师提供的医学营养疗法（MNT）对血压（BP）的影响是什么，与标准护理或无干预相比，心血管风险和事件以及人体测量？
方法：MEDLINE，在CINAHL和CochraneCentral数据库中搜索了1985-2022年发表在同行评审期刊上的随机对照试验（RCT）。使用2版CochraneRCT工具评估偏倚风险(RoB)。使用DerSimonian-Laird随机效应模型进行Meta分析。使用建议分级评估每个结果的证据确定性(COE)，评估,和评估(等级)方法。
结果：纳入并分析了代表31项随机对照试验的40篇文章。营养师提供的MNT可能会降低收缩压[平均差（MD）：-3.63mmHg（95％置信区间（CI）：-4.35，-2.91）]和舒张压[-2.02mmHg（-2.56，-1.49）]BP（p<0.001）和体重[-1.84kg（-2.72，-0.96），p<0.001],改善抗高血压药物的使用，中风的相对风险[0.34（0.14，0.81），p=0.02]和CVD风险评分[标准化平均差（SMD）：-0.20（-0.30，-0.09），p<0.001]与对照参与者相比，COE适中。此外,MNT可以降低动脉僵硬度[SMD：-0.45（-0.71，-0.19），p=0.008]和腰围[-1.18cm(-2.00,-0.36),p=0.04]，COE很低。两组之间的心肌梗死风险没有显着差异。营养师干预降低了高血压前期或高血压成人的血压和相关心血管结局。
结论：营养师在改善成人血压升高的心脏代谢危险因素方面发挥着关键作用；因此，改善MNT服务的支付和获取有可能对公共卫生产生重大影响。
■此系统评价已在国际系统评价前瞻性注册簿中注册：PROSPERO#CRD42022351693（https://www.crd.约克。AC.uk/prospro/display_record.php?ID=CRD42022351693)。
