An Evidence Informed Analysis of Acupuncture for Essential Hypertension
Essential Hypertension is an endemic affecting over 1 billion people globally of unknown cause and remains a public health challenge. The disease may be used as an early detector of heart attack, stroke and kidney disease.1 In addition, anti-hypertensive medications have various side effects, non-compliance issues, and safety concerns, such as drug resistance.2
Acupuncture is considered a promising adjunct for essential hypertension. Further research should lead to the development and validation of a new strategy for the management of hypertension that integrates acupuncture and other physiologic therapeutics.
The following study and review from PubMed showed coinciding positive results in the effect of acupuncture on hypertension. In Yin, et al.'s study,3 a randomized, double-blind, placebo-controlled trial (RCT) was done on hypertensive subjects on anti-hypertensive medication. Out of 41 hypertensive (systolic BP ≥ 120 mmHg or diastolic BP ≥ 80 mmHg) volunteers who were recruited and randomly assigned into real or sham acupuncture groups, 30 subjects completed the intervention.
The Study Results
Starting from the first day of the study, 17 sessions were performed with 3-4 day intervals between sessions for eight weeks. The acupuncture formula for a given subject was selected from four pre-made Korean Saam acupuncture prescriptions once the constitutional energy traits of the subject was considered. The physician who performed the acupuncture treatment selected the prescription, and the selected prescription was not changed during the intervention period. In the real acupuncture group, the needle punctured the skin and was twisted in a specific manner to search for the Deqi sensation. In the sham acupuncture group, the needle did not penetrate the skin, but was twisted slowly to imitate real acupuncture. After the Deqi sensation was detected, the needle was withdrawn immediately.
During each acupuncture session, any adverse effect was recorded using a checklist of adverse reactions. The answers to the question on adverse reaction of acupuncture also served to find out if the blinding for the subjects was being successfully maintained. If the subject gave an answer implying that the acupuncture session was unusual to their previous experience of acupuncture or the needle did not penetrate the skin, the subject was expected to be dropped out.
As a result, the sham acupuncture group showed no significant change in mean BP, while the real acupuncture group showed a significant (p<0.01) decrease in mean BP after eight weeks of intervention from 136.8/83.7 to 122.1/76.8 mmHg.
Zhao, et al.2 did a systematic review and meta-analysis on 23 RCTs involving 1,788 patients. Most trials had an unclear risk of bias regarding allocation concealment, blinding, incomplete outcome data and selective reporting. In addition, current evidence from the review may not be sufficiently robust against methodological flaws and significant heterogeneity of the included RCTs. Hence, larger high-quality trials are needed.
Acupuncture is More Effective
Compared with sham acupuncture plus medication, a meta-analysis of two trials revealed that acupuncture as an adjunct to medication was more effective on systolic (SBP) and diastolic (DBP) blood pressure change magnitude (n=170, SBP: mean difference (MD)=-7.47, 95 percent confidence intervals (CIs) [-10.43, -4.51], I^2=0 percent; DBP: -4.22, [-6.26, -2.18]). A subgroup analysis of four trials also showed acupuncture combined with medication was superior to medication on efficacy rate (n=230, odds ratio (OR)=4.19, 95 percent CI [1.65, 10.67], I^2=0 percent). By contrast, compared with medication, acupuncture alone showed no significant effect on SBP/DBP after intervention and efficacy rate in the subgroup analysis. (7 trials with 510 patients; 10 trials with 963 patients, OR=1.14, 95 percent CI [0.70, 1.85], I^2=54 percent). Adverse events were inadequately reported in most RCTs.
The indications from these studies conclude that acupuncture can be an effective treatment modality for hypertension combined with western medicine. It may improve clinical symptoms and raise quality of life in patients more potently than with western medicine alone. The systematic review and RCT both provide strong evidence and promote reliability.
References
Katz DL, Elmore JG, et al. Jekel's epidemiology, biostatistics, preventative medicine & public health (4th Ed.). Philadelphia: Saunders, 2014.
Zhao XF, Hu HT, et al. Is Acupuncture Effective for Hypertension? PLoS ONE,2015; 10(7), 1-21.
Yin CS, et al. Acupuncture, a promising adjunctive therapy for essential hypertension: a double-blind, randomized, controlled trial. Neuro Research, 2007; 29, S98-103.
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