CRITICAL APPRAISAL on

Meta-analysis Study
 Effect of green tea consumption on blood
pressure: A meta-analysis of 13
randomized controlled trials
Peng X, Zhou R, Wang B, Yu X, Yang X, Liu K and Mi M. (2014). Effect of green tea
consumption on blood pressure: A meta-analysis of 13 randomized controlled trials.
Scientific Reports. 4:6251. DOI: 10.1038/srep06251
ABSTRACT
● The aim of this study is to quantitatively evaluate the effects of green tea
on BP control.
● PubMed, Embase, and the Cochrane Library (updated to March 2014) were
searched for randomized controlled trials evaluating the effects of green
tea on BP.
● Pooled effect of green tea consumption on BP was evaluated using fixed-
effects or random-effects model.
● Thirteen trials comprising a total of 1,367 subjects were included in the
current meta-analysis.
ABSTRACT
● The overall outcome of the meta-analysis suggested that green tea
consumption significantly decrease systolic blood pressure (SBP) level by -
1.98 mmHg (95% CI: -2.94, -1.01 mmHg; P ,0.001) and on diastolic blood
pressure (DBP) in treatment group (-1.92 mmHg; 95% CI: -3.17, -0.68
mmHg; P=0.002).
● Subgroup analyses further suggested that the positive effect of green tea
polyphenols on BP was only showed in studies using a low-dose green tea
polyphenol, with the long-term intervention duration or ruling out the
confounding effects of caffeine. The meta-analysis suggested that green
tea consumption had a favorable effect on decrease of BP.
Critical Appraisal of a Meta-analysis
● Adapted from Crombie, The Pocket Guide to Critical Appraisal;

○ The critical appraisal approach used by the Oxford Centre for Evidence
Medicine, checklists of the Cochrane Centre, BMJ editor’s checklists
and the checklists of the EPPI Centre.

● Version 13 Feb 2014

Critical Appraisal of a Meta-analysis: CHECKLIST
1. Did the study address a clearly focused question?
2. Was a comprehensive literature search conducted using
relevant research databases?
3. Is the search systematic and reproducible?
4. Has publication bias been prevented as far as possible?
5. Are the inclusion and exclusion criteria clearly defined?
6. Was the methodological quality of each study assessed
using predetermined quality criteria?
Critical Appraisal of a Meta-analysis: CHECKLIST
7. Are the key features of the included studies described?
8. Has the meta-analysis been conducted correctly?
9. Were the results similar from study to study?
10. Is the effect size practical relevant?
11. How precise is the estimate of the effect? Were
confidence intervals given?
12. Can the results be applied to your organization?
1. Did the study address a clearly focused question?

● YES
● Abstract / Introduction
● Page 1; 1st Paragraph
2. Was a comprehensive literature search
conducted using relevant research databases?
● YES
● Methods: Search Strategy
● Page 6; 1st Paragraph

Comment:
Other sources of studies such as hand-searching key journals, request on listservs –
electronic mailing list and personal communication with experts or key researchers were
not utilized by the authors.
3. Is the search systematic and reproducible?
● YES
● Methods: Search Strategy
● Page 6
4. Has publication bias been prevented as far as
possible?
● YES
● Results: Publication Bias
● Page 2
5. Are the inclusion and exclusion criteria clearly
defined?
● YES
● Methods: Study Selection
● Page 6
6. Was the methodological quality of each study
assessed using predetermined quality criteria?
● YES
● Methods:
Data
extraction
and quality
assessment
● Page 6
7. Are the key features of the included studies
described? ● YES
● Table 1. Characteristics of 13 randomized controlled trials
included in analysis; Page 3
8. Has the meta-analysis been conducted correctly?

● YES
● Introduction & Methods
● Page 1; 6
9. Were the results similar from study to study?

● NO
● Discussion: Figures 2 & 3
● Page 2 – 3
10. Is the effect size practical relevant?

● NO
● Results
● Page 2
11. How precise is the estimate of the effect? Were
confidence intervals given?
● YES
● Results:
Figure 2
&3
● Page 4
12. Can the results be applied to your organization?

● YES
● Green tea is available locally
● Low dose of green tea has significant effect
● Population of the studies:

○ Age: 18 – 70 years old

○ Prehypertension, Stage 1 Hypertension

○ Usual diet
Will I recommend the
use of green tea to
decrease blood
pressure?
Will I recommend the use of green tea to decrease
blood pressure?
● For now, no.
● Effect size is not clinically relevant
● Individual study has several limitations
● Authors cannot yet also recommend specific dietary recommendations for
lowering blood pressure.