高鉀的攝入對心血管危險因素的影響的系統(tǒng)性文獻回顧和薈萃分析

Effectofincreasedpotassiumintakeoncardiovascularriskfactorsanddisease:systematicreviewandmeta-analysesIntroductionNon-communicablediseasesaretheleadingcauseofdeathglobally,killingmorepeopleeachyearthanallothercausescombined.Elevatedbloodpressureandhypertensionaremajorriskfactorsforcardiovasculardiseases,especiallycoronaryheartdisease,stroke,andheartfailure,aswellasrenalfailure.Althoughnon-communicablediseasesdisproportionatelyaffectadults,theyandtheirriskfactorsarebecomingmoreprevalentinpaediatricpopulations.IntroductionPotassiumisanessentialnutrientthatisneededformaintenanceoftotalbodyfluidvolume,acidandelectrolytebalance,andnormalcellfunctionpost-agriculturaldiets200mmol/dayInmodernsocietybelow70-80mmol/dayLowerpotassiumconsumptionhasbeenassociatedwithelevatedbloodpressure,hypertension,andstroke,andhigherlevelsofconsumptioncouldbeprotectiveagainsttheseconditionsIntroductionToinformthedevelopmentofitsguidelineonpotassiumintake,theWHOinitiatedthisreviewtosystematicallycompileresultsfromstudiesinapparentlyhealthyadultsandchildrenwithoutacuteillnessesorrenalimpairmentthatcouldcompromisehandlingofpotassiumandtoconductmeta-analysestoanswerthefollowingquestionsIntroduction(1)Whatistheeffectofincreasedpotassiumintakecomparedwithlowerintakeonbloodpressure,allcausemortality,cardiovasculardisease,stroke,andcoronaryheartdiseaseinapparentlyhealthyadults?(2)Whatistheeffectofincreasedpotassiumintakeonbloodpressureinapparentlyhealthychildren?(3)Whatistheeffectofincreasedpotassiumintakeonthepotentialadverseeffectsofchangesinbloodlipidconcentrations,catecholamineconcentrations,andrenalfunctioninapparentlyhealthyadultsandchildren?Introduction(4)Whatisthelevelofpotassiumintakethatresultsinthemaximumbenefitonbloodpressureandriskofmortalityandcardiovasculardiseases?(5)Istheeffectofincreasedpotassiumdifferentiallyaffectedbythehypertensionstatusofthepopulation,sex,averagesodiumorpotassiumintakeatbaseline,typeofintervention,typeofdeviceormethodusedtomeasurebloodpressure,studydesign,ordurationofintervention?MethodsWeconductedthisreviewaccordingtothemethodsrecommendedbytheCochraneCollaborationanddocumentedtheprocessandresultsinaccordancewiththepreferredreportingitemsforsystematicreviewsandmeta-analyses(PRISMA)statementforreportingsystematicreviewsSearchstrategyWedidacompletesearchoftheliteratureonpotassiumintakeandtheoutcomesofinterestpublishedsincethedatasearchoftheidentifiedsystematicreview(s).

Medline(28August2011),Embase(25August2011),theWHOInternationalClinicalTrialsRegistryPlatform(1September2011),and(LILACS)(1September2011).StatisticalanalysisOnereviewerentereddataintoReviewManagersoftware(Copenhagen,2011),secondreviewercheckeddataentryforaccuracy.Incasesofdisagreement,thirdrevieweralsoevaluatedthedataandallreviewersmadeaconclusionbasedonconsensus.ResultsResultsResultsResultsResultsResultsrandomisedcontrolledtrials(including1606participants)reportingbloodpressure,bloodlipids,catecholamineconcentrations,andrenalfunctionand11cohortstudies(127038participants)reportingallcausemortality,cardiovasculardisease,stroke,orcoronaryheartdiseaseinadultswereincludedinthemeta-analyses.ResultsIncreasedpotassiumintakereducedsystolicbloodpressureby3.49(95%confidenceinterval1.82to5.15)mmHganddiastolicbloodpressureby1.96(0.86to3.06)mmHginadults,aneffectseeninpeoplewithhypertensionbutnotinthosewithouthypertension.Systolicbloodpressurewasreducedby7.16(1.91to12.41)mmHgwhenthehigherpotassiumintakewas90-120mmol/day,withoutanydosresponse.ConclusionsIncreasedpotassiumintakereducesbloodpressureinpeoplewithhypertensionandhasnoadverseeffectonbloodlipidconcentrations,catecholamineconcentrations,orrenalfunctioninadults.Inthemeta-analysesofthethreerandomisedcontrolledtrialsinchildren,increasedpotassiumintakedecreasedsystolicbloodpressurebyanon-significantConclusionsHigherpotassiumin