Abstract-Case studies and small trials suggest that acupuncture may effectively treat hypertension, but no large randomized trials have been reported. 3 Modalities of complementary and alternative medicine, including acupuncture, are being used by patients with increasing frequency, 4 but these therapies lack demonstrated efficacy and safety for treating cardiovascular disease and hypertension. 5 Acupuncture has been used in traditional Chinese medicine (TCM) to treat symptoms related to hypertension for Ͼ2500 years. 6 Today, acupuncture is commonly used to treat hypertension in China and the West. [7][8][9] The efficacy of acupuncture is well supported for treating postoperative dental pain 10 and nausea 11,12 with few reported adverse effects. 13 Acupuncture has been found effective for treating a number of other acute 14 -16 and chronic 17,18 conditions in a growing number of randomized trials, although opinion differs on the role of placebo effects. 19,20 Mechanistic studies have demonstrated effects of acupuncture on the activity and plasma concentrations of blood pressure modulators, including: renin, aldosterone, angiotensin II, norepinephrine, serotonin, enkephalins, and ␤-endorphins. [21][22][23][24][25][26][27][28][29] The efficacy of acupuncture for treating hypertension is suggested by a large number of published case series and uncontrolled trials. 22,23,25,30 -32 Three randomized trials 33-35 reported significant reductions in BP relative to randomly assigned control groups treated for 4 to 8 weeks, whereas 3 others did not report significant effects of acupuncture relative to control subjects. 36 -38 They were all relatively small trials (nϭ10 to 68), and all but Yin et al 35 were limited

Isolated systolic hypertension is common in the elderly, but decreasing systolic blood pressure (SBP) without lowering diastolic blood pressure (DBP) remains a therapeutic challenge. Although stress management training, in particular eliciting the relaxation response, reduces essential hypertension its efficacy in treating isolated systolic hypertension has not been evaluated. We conducted a double-blind, randomized trial comparing 8 weeks of stress management, specifically relaxation response training (61 patients), versus lifestyle modification (control, 61 patients). Inclusion criteria were Ն55 years, SBP 140-159 mm Hg, DBP Ͻ90 mm Hg, and at least two antihypertensive medications. The primary outcome measure was change in SBP after 8 weeks. Patients who achieved SBP Ͻ140 mm Hg and Ն5 mm Hg reduction in SBP were eligible for 8 additional weeks of training with supervised medication elimination. SBP decreased 9.4 (standard deviation [SD] 11.4) and 8.8 (SD 13.0) mm Hg in relaxation response and control groups, respectively (both ps Ͻ 0.0001) without group difference (p ϭ 0.75). DBP decreased 1.5 (SD 6.2) and 2.4 (SD 6.9) mm Hg (p ϭ 0.05 and 0.01, respectively) without group difference (p ϭ 0.48). Forty-four (44) in the relaxation response group and 36 in the control group were eligible for supervised antihypertensive medication elimination. After controlling for differences in characteristics at the start of medication elimination, patients in the relaxation response group were more likely to successfully eliminate an antihypertensive medication (odds ratio 4.3, 95% confidence interval 1.2-15.9, p ϭ 0.03). Although both groups had similar reductions in SBP, significantly more participants in the relaxation response group eliminated an antihypertensive medication while maintaining adequate blood pressure control. 129

No abstract