CME Article:Long-Lasting Reduction of Blood Pressure by Electroacupuncture in Patients with Hypertension: Randomized Controlled Trial

Abstract

Background: Acupuncture at specific acupoints has experimentally been found to reduce chronically elevated blood pressure.Objective: To examine effectiveness of electroacupuncture (EA) at select acupoints to reduce systolic blood pressure (SBP) and diastolic blood pressures (DBP) in hypertensive patients.Design: Two-arm parallel study.Patients: Sixty-five hypertensive patients not receiving medication were assigned randomly to one of the two acupuncture intervention (33 versus 32 patients).Intervention: Patients were assessed with 24-hour ambulatory blood pressure monitoring. They were treated with 30-minutes of EA at PC 5-6+ST 36-37 or LI 6-7+GB 37-39 once weekly for 8 weeks. Four acupuncturists provided single-blinded treatment.Main outcome measures: Primary outcomes measuring effectiveness of EA were peak and average SBP and DBP. Secondary outcomes examined underlying mechanisms of acupuncture with plasma norepinephrine, renin, and aldosterone before and after 8 weeks of treatment. Outcomes were obtained by double-blinded evaluation.Results: After 8 weeks, 33 patients treated with EA at PC 5-6+ST 36-37 had decreased peak and average SBP and DBP, compared with 32 patients treated with EA at LI 6-7+GB 37-39 control acupoints. Changes in blood pressures significantly differed between the two patient groups. In 14 patients, a long-lasting blood pressure–lowering acupuncture effect was observed for an additional 4 weeks of EA at PC 5-6+ST 36-37. After treatment, the plasma concentration of norepinephrine, which was initially elevated, was decreased by 41%; likewise, renin was decreased by 67% and aldosterone by 22%.Conclusions: EA at select acupoints reduces blood pressure. Sympathetic and renin-aldosterone systems were likely related to the long-lasting EA actions.

Effect of Acupuncture on the Motor and Nonmotor Symptoms in Parkinson's Disease—A Review of Clinical Studies

“…It was suggested that the therapeutic effect of acupuncture on bladder dysfunction might be attributed to its modulation on autonomic system and central cholinergic activity [60]. In non-PD patients, electroacupuncture treatment significantly improved chronic bladder dysfunction in patients with traumatic spinal cord injury [61] and had a long-lasting reduction of blood pressure in patients with mild-to-moderate hypertension [62].…”

Acupuncture to treat hypertension: a recent systematic review and implications for subsequent research

“…In the focal review, only three trials used an ABPM device. A recently published trial by Li et al 7 , which was not included in this SR, did use an ABPM device; the trial showed a significant BP reduction in the acupuncture group. Li et al 8 reported a protocol for acupuncture to treat mild hypertension; they also used an ABPM device, because ABPM is better than clinical BP measurement in predicting cardiovascular events.…”

“…It is known that increased activity in the renin–angiotensin–aldosterone system (RAAS), as well as in the sympathetic nervous system (SNS), causes hypertension 12 . In a preliminary study, acupuncture reduced elevated renin, aldosterone, and norepinephrine levels, implying lowered activity in both the RAAS and the SNS 7 . In some clinical trials, the results of treatment using acupoint combinations such as PC5-6 or ST36-37 have been better than those of treatment using LI6-7 or GB37-39; this implies that acupoint specificity is important 7, 12.…”

“…In a preliminary study, acupuncture reduced elevated renin, aldosterone, and norepinephrine levels, implying lowered activity in both the RAAS and the SNS 7 . In some clinical trials, the results of treatment using acupoint combinations such as PC5-6 or ST36-37 have been better than those of treatment using LI6-7 or GB37-39; this implies that acupoint specificity is important 7, 12. According to a review by Longhurst 13 , the use of acupoints located on deep somatic nerves (such as PC5-6, ST36-37, LI4-7, and LI10-11) evoked greater activity in the rostral ventrolateral medulla, and reduced BP more, than the use of acupoints located on superficial nerves.…”

Does acupuncture reduce the risk of acute myocardial infarction?

“…Mechanism is also important. In a recent acupuncture trial for hypertension, baseline plasma norepinephrine and renin levels were higher in the responder group than in the nonresponder group 18 . The factors that predict responders to acupuncture from among patients with CVD might be identified by performing a retrospective cohort or observational study.…”