Medical Orient Express (Jan-Feb-March 2024)

1. Could Tai Chi Be Better Than Aerobic Exercise in Improving Blood Pressure in Prehypertension?
2. Panax Notoginseng Extract May Speed Up Neural Deficit Recovery From Ischemic Stroke

1. Could Tai Chi Be Better Than Aerobic Exercise in Improving Blood Pressure in Prehypertension?

IMPORTANCE: Prehypertension increases the risk of developing hypertension and other cardiovascular diseases. Early and effective intervention for patients with prehypertension is highly important.

OBJECTIVE: To assess the efficacy of Tai Chi vs aerobic exercise in patients with prehypertension.

DESIGN, SETTING, AND PARTICIPANTS: This prospective, single-blinded randomized clinical trial was conducted between July 25, 2019, and January 24, 2022, at 2 tertiary public hospitals in China. Participants included 342 adults aged 18 to 65 years with prehypertension, defined as systolic blood pressure (SBP) of 120 to 139 mm Hg and/or diastolic BP (DBP) of 80 to 89 mm Hg.

INTERVENTIONS: Participants were randomized in a 1:1 ratio to a Tai Chi group (n = 173) or an aerobic exercise group (n = 169). Both groups performed four 60-minute supervised sessions per week for 12 months.

MAIN OUTCOMES AND MEASURES: The primary outcome was SBP at 12 months obtained in the office setting. Secondary outcomes included SBP at 6 months and DBP at 6 and 12 months obtained in the office setting and 24-hour ambulatory BP at 12 months.

RESULTS: Of the 1189 patients screened, 342 (mean [SD] age, 49.3 [11.9] years; 166 men [48.5%] and 176 women [51.5%]) were randomized to 1 of 2 intervention groups: 173 to Tai Chi and 169 to aerobic exercise. At 12 months, the change in office SBP was significantly different between groups by −2.40 (95% CI, −4.39 to −0.41) mm Hg (P = .02), with a mean (SD) change of −7.01 (10.12) mm Hg in the Tai Chi group vs −4.61 (8.47) mm Hg in the aerobic exercise group. The analysis of office SBP at 6 months yielded similar results (−2.31 [95% CI, −3.94 to −0.67] mm Hg; P = .006). Additionally, 24-hour ambulatory SBP (−2.16 [95% CI, −3.84 to −0.47] mm Hg; P = .01) and nighttime ambulatory SBP (−4.08 [95% CI, −6.59 to −1.57] mm Hg; P = .002) were significantly reduced in the Tai Chi group compared with the aerobic exercise group.

CONCLUSIONS AND RELEVANCE: In this study including patients with prehypertension, a 12-month Tai Chi intervention was more effective than aerobic exercise in reducing SBP. These findings suggest that Tai Chi may help promote the prevention of cardiovascular disease in populations with prehypertension.

Li XY, et al. Effect of Tai Chi vs Aerobic Exercise on Blood Pressure in Patients With Prehypertension. JAMA Netw Open. 2024 Feb; 7(2): e2354937. Published online 2024 Feb 9. doi: 10.1001/jamanetworkopen.2023.54937

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2. Panax Notoginseng Extract May Speed Up Neural Deficit Recovery From Ischemic Stroke

IMPORTANCE: Preclinical and clinical studies have suggested the neuroprotective effect of Panax notoginseng saponins (Xuesaitong soft capsules). However, robust evidence in patients with ischemic stroke is lacking.

OBJECTIVE: To assess the efficacy and safety of Xuesaitong soft capsules in patients with ischemic stroke.

DESIGN, SETTING AND PARTICIPANTS: This multicenter, double-blind, placebo-controlled randomized clinical trial was conducted at 67 tertiary health centers in China from July 1, 2018, to June 30, 2020. Included patients were aged 18 to 75 years with a diagnosis of ischemic stroke and a National Institutes of Health Stroke Scale score between 4 and 15.

INTERVENTIONS: Eligible patients were randomly assigned within 14 days after symptom onset to receive either treatment with Xuesaitong soft capsules (120 mg orally twice daily) or placebo (120 mg orally twice daily) for 3 months.

MAIN OUTCOMES AND MEASURES: The primary outcome was functional independence at 3 months, defined as a modified Rankin Scale score of 0 to 2.

RESULTS: Among 3072 eligible patients with ischemic stroke who were randomized, 2966 (96.5%) were included in the modified intention-to-treat cohort (median [IQR] age, 62 [55-68] years; 1982 male [66.8%]). The number of patients who achieved functional independence at 3 months was 1328 (89.3%) in the Xuesaitong group and 1218 (82.4%) in the control group (odds ratio, 1.95; 95% CI, 1.56-2.44; P < .001). In the safety cohort, serious adverse events occurred in 15 of 1488 patients (1.0%) in the Xuesaitong group and 16 of 1482 (1.1%) in the control group (P = .85).

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, Xuesaitong soft capsules significantly increased the likelihood of functional independence at 3 months in patients with ischemic stroke, indicating that this may be a safe and effective alternative therapy to improve prognosis in this population.

Wu LF, et al. Efficacy and Safety of Panax notoginseng Saponins in the Treatment of Adults With Ischemic Stroke in China: A Randomized Clinical Trial. JAMA Netw Open. 2023 Jun 1;6(6):e2317574. doi: 10.1001/jamanetworkopen.2023.17574.

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