The effect of transcutaneous electric nerve stimulation in patients with therapy-resistant hypertension

Jacobsson, Filip; Himmelmänn, Anders; Bergbrant, A; Svensson, Ann Marie; Mannheimer, Clas

doi:10.1038/sj.jhh.1001112

Cited by 29 publications

(28 citation statements)

References 20 publications

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“…For healthy subjects, low-frequency TENS reduced sympathetic and increased parasympathetic modulation; however, at high frequencies, these results were the opposite (10). In this regard, the chronic application of low-frequency TENS reduced arterial systolic and diastolic pressure in hypertensive patients (11,12). However, recent studies have demonstrated that, at low frequency, TENS did not modify the values of systemic arterial pressure in normotensive (32) and hypertensive volunteers (13).…”

Section: Discussionmentioning

confidence: 98%

Effects of different frequencies of transcutaneous electrical nerve stimulation on venous vascular reactivity

Franco

Paulitsch

Pereira

et al. 2014

Braz J Med Biol Res

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Transcutaneous electrical nerve stimulation (TENS) is a type of therapy used primarily for analgesia, but also presents changes in the cardiovascular system responses; its effects are dependent upon application parameters. Alterations to the cardiovascular system suggest that TENS may modify venous vascular response. The objective of this study was to evaluate the effects of TENS at different frequencies (10 and 100 Hz) on venous vascular reactivity in healthy subjects. Twenty-nine healthy male volunteers were randomized into three groups: placebo (n=10), low-frequency TENS (10 Hz, n=9) and high-frequency TENS (100 Hz, n=10). TENS was applied for 30 min in the nervous plexus trajectory from the superior member (from cervical to dorsal region of the fist) at low (10 Hz/200 μs) and high frequency (100 Hz/200 μs) with its intensity adjusted below the motor threshold and intensified every 5 min, intending to avoid accommodation. Venous vascular reactivity in response to phenylephrine, acetylcholine (endothelium-dependent) and sodium nitroprusside (endothelium-independent) was assessed by the dorsal hand vein technique. The phenylephrine effective dose to achieve 70% vasoconstriction was reduced 53% (P<0.01) using low-frequency TENS (10 Hz), while in high-frequency stimulation (100 Hz), a 47% increased dose was needed (P<0.01). The endothelium-dependent (acetylcholine) and independent (sodium nitroprusside) responses were not modified by TENS, which modifies venous responsiveness, and increases the low-frequency sensitivity of α1-adrenergic receptors and shows high-frequency opposite effects. These changes represent an important vascular effect caused by TENS with implications for hemodynamics, inflammation and analgesia.

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Section: Discussionmentioning

confidence: 98%

Effects of different frequencies of transcutaneous electrical nerve stimulation on venous vascular reactivity

Franco

Paulitsch

Pereira

et al. 2014

Braz J Med Biol Res

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“…This interaction of TENS with the cardiovascular system is demonstrated by vasodilation (Cramp et al, 2000;Miller, Gruben, & Morgan, 2000;Sherry et al, 2001;Vieira et al, 2012), increased blood in peripheral and coronary blood flow (Chauhan et al, 1994;Jessurun et al, 1998;Cramp et al, 2000;Miller et al, 2000;Sandberg, Sandberg, & Dahl, 2007), decreased peripheral vascular resistance (Mannheimer, Emanuelsson, & Waagstein, 1990;Sherry et al, 2001), and heart rate (Nitz, 2003). The combination of these mechanisms reduces the blood pressure demonstrated in healthy volunteers (Sherry et al, 2001;Nitz, 2003;Vieira et al, 2012) and in hypertensive patients (Kaada et al, 1991;Jacobsson et al, 2000). Previous studies have demonstrated the therapeutic potential of TENS (70 Hz) in patients with severe coronary artery disease, in which the application on the chest region showed decreased angina pectoris crisis, reduced circulating levels of epinephrine and norepinephrine (Mannheimer et al, 1990;Chauhan et al, 1994), attenuation of ST segment depression (Mannheimer et al, 1985), reduced systolic blood pressure (Mannheimer et al, 1990) and nitroglycerin consumption (Mannheimer et al, 1985).…”

Section: Discussionmentioning

confidence: 99%

“…TENS is presented as a potential non-pharmacological resource that can be applied in the management of some cardiovascular diseases, such as hypertension (Chauhan et al, 1994;Cramp, Gilsenan, Lowe, & Walsh, 2000;Raimundo et al, 2009;Stein et al, 2011). Previous studies have demonstrated that TENS application reduced the systemic blood pressure of healthy volunteers (Sherry, Oehrlein, Hegge, & Morgan, 2001;Nitz, 2003;Vieira et al, 2012) and hypertensive patients (Kaada, Flatheim, & Woie, 1991;Jacobsson, Himmelmann, Bergbrant, Svensson, & Mannheimer, 2000). However, these results have not been confirmed by other studies (Lazarou & Athanasios, 2009), thus its application is still questionable in this clinical condition.…”

Section: Introductionmentioning

confidence: 99%

<b>Different frequencies of transcutaneous electrical nerve stimulation on sympatho-vagal balance

Nardi¹,

Hauck²,

Franco³

et al. 2017

Acta Sci. Health Sci.

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ABSTRACT. This study aims to evaluate the effects of TENS at different frequencies on autonomic balance in healthy volunteers. It is a case-control study, and was composed of fourteen healthy volunteers (5 women) with 28 (3.9) years old who underwent low ) and high (100 Hz 200ms -1 ) frequency TENS. The interventions were randomized and applied for 30 minutes in the trajectory brachial nerve plexus from non-dominant member. Intensities were adjusted every 5 minutes and maintained below motor threshold. The autonomic balance was assessed before and after interventions by heart rate variability (HRV). TENS 10 Hz increased 10% sympathetic activity and decreased 10% parasympathetic activity; however, TENS 100 Hz showed opposite effects (p < 0.05). The sympatho-vagal balance increased with low frequency TENS and decreased with high frequency (p < 0.05). It can be concluded that different frequencies of TENS applied in the trajectory brachial nerve plexus modify cardiovascular autonomic responses. High frequency TENS reduces sympathetic activity and increases the parasympathetic, which favors beneficial effects on autonomic balance in healthy volunteers.Keywords: electric stimulation, autonomic nervous system, heart rate.Diferentes frequências da estimulação elétrica nervosa transcutânea no balanço simpatovagal RESUMO. Este estudo objetiva avaliar os efeitos de diferentes frequências da TENS sobre o balanço autonômico em voluntários saudáveis. Estudo caso-controle composto de quatorze voluntários saudáveis (5 mulheres), com 28 (3,9) anos de idade que foram submetidos a baixa (10 Hz 200 ms ) frequências da TENS. As intervenções foram randomizadas e aplicadas por 30 minutos sobre a trajetória do plexo nervoso braquial do membro não dominante. As intensidades foram ajustadas a cada 5 minutos e mantidas abaixo do limiar motor. O balanço autonômico foi avaliado antes e após as intervenções pela variabilidade da frequência cardíaca (VFC). TENS a 10 Hz aumentou 10% da atividade simpática e diminui 10% a atividade parassimpática, mas a TENS a 100 Hz apresentou efeitos opostos (p < 0,05). O balanço simpato-vagal aumentou com a TENS de baixa frequência e diminuiu com a alta frequência (p < 0,05). Conclui-se que as diferentes frequências da TENS aplicadas sobre a trajetória do plexo nervoso braquial modificam as respostas autonômicas cardiovasculares. A alta frequência da TENS reduz a atividade simpática e aumenta a parassimpática, o que favorece aos efeitos benéficos sobre o balanço autonômico em voluntários saudáveis.Palavras-chave: estimulação elétrica, sistema nervoso autônomo, frequência cardíaca.

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“…In this regard, several recent review publications have expressed concern regarding the lack of controls and the potential for placebo effects in prior studies, and have made several pertinent suggestions for improving future studies [26]. Improvements for future study of acupuncture in hypertension include 24-h ambulatory BP monitoring to obtain a more accurate recording of the dynamic 24 h changes in BP [27].…”

Section: Limitations Of Previous Clinical Acupuncture Researchmentioning

confidence: 97%

Review of Trials Examining the Use of Acupuncture to Treat Hypertension

Zhou

Longhurst

2006

Future Cardiol.

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Although hypertension is a major risk factor for heart attack and stroke in the US, only approximately a quarter of adults receive adequate hypertension treatment and control their blood pressure (BP) effectively. There are disparities in the prevalence of hypertension, its treatment and control with respect to age, sex, racial groups and education. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of high BP (JNC 7 report) provides lifestyle modification with and without pharmacological intervention recommendations for preventing and treating different stages of hypertension. Recently, nonpharmacological approaches including yoga, meditation, acupressure and acupuncture have been considered as potential therapeutic options. Acupuncture has been used empirically for nearly 3000 years to treat a variety of diseases, including cardiovascular disorders such as hypertension, hypotension, coronary disease and certain arrhythmias. Previous studies suggest that short and chronic elevation in BP can be lowered in animal models and human subjects. However, the mechanisms underlying the antihypertensive effects of acupuncture are not yet fully understood. An increasing interest in acupuncture healthcare has led to a growing number of investigators to pursue research in this field. This article briefly summarizes available studies, including our own reports, that demonstrate evidence for acupuncture modulation of cardiovascular function, particularly BP reduction, and concludes that future treatment of hypertension can potentially include acupuncture as a nonpharmacological intervention.

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The effect of transcutaneous electric nerve stimulation in patients with therapy-resistant hypertension

Cited by 29 publications

References 20 publications

Effects of different frequencies of transcutaneous electrical nerve stimulation on venous vascular reactivity

Effects of different frequencies of transcutaneous electrical nerve stimulation on venous vascular reactivity

<b>Different frequencies of transcutaneous electrical nerve stimulation on sympatho-vagal balance

Review of Trials Examining the Use of Acupuncture to Treat Hypertension

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