Nondrug therapies for hypertensive patients complicated with cervical spondylosis: A systematic review and meta-analysis

Purpose:The aim of this study was to systematically evaluate the efficacy and safety of nondrug therapies for hypertensive patients complicated with cervical spondylosis.Methods:Randomized controlled trials (RCTs) concerned with nondrug therapies for hypertensive patients complicated with cervical spondylosis were identified by searching 5 English and Chinese databases. Study selection, data extraction, and risk of bias assessment were conducted independently by 2 authors. RevMan 5.3 software was used for meta-analysis with effect estimate presented as relative risk (RR) and mean difference (MD) with a 95% confidence interval (CI).Results:A total of 13 studies involving 929 patients were included. The majority of the included trials were assessed to be of high clinical heterogeneity and high risk of bias. The results of meta-analysis showed that there was a significant improvement in the effectiveness rate of cervical vertebra symptoms (RR=1.67, 95% CI [1.33, 2.10], P<.0001), effectiveness rate of blood pressure lowering (RR=1.35, 95% CI [1.06, 1.71], P=.02), systolic blood pressure reduction (MD=-11.05, 95% CI [-14.12, -7.98] mmHg, P<.0001), and diastolic blood pressure reduction (MD=-6.96, 95% CI [-8.89, -5.04] mmHg, P<.00001). Nondrug therapies had no significant difference compared with drugs in the effectiveness rate of overall improvement (RR=1.3, 95% CI [0.93, 1.82], P=.12). There were no serious adverse effects related to nondrug therapies in the included trials.Conclusion:The results show sound advantages of nondrug therapies over conventional medicine or sham procedure in efficacy. However, the evidence remains weak because of the high clinical heterogeneity and high risk of the included trials. Therefore, further thorough investigation, large-scale, proper-designed, randomized trials of nondrug therapies for hypertension complicated with cervical spondylosis are warranted.Prospero registration number:CRD2019123175.