Acupuncture for Lowering Blood Pressure - Acupuncture for Lowering Blood Pressure

Description:

The goal of the trial was to evaluate the effect of acupuncture on blood pressure lowering in patients with mild or moderate arterial hypertension.

Hypothesis:

Acupuncture would reduce blood pressure in outpatients with uncomplicated mild to moderate hypertension.

Study Design

Study Design:

Patients Screened: 342
Patients Enrolled: 160
Mean Follow Up: 6 months
Mean Patient Age: Mean age, 58 years
Female: 51

Patient Populations:

Mild or moderate arterial hypertension, defined as SBP from 140 to 179 mm Hg, and DBP from 90 to 109 mm Hg documented by at least 2 readings ≥140/90 or a history of hypertension with current use of antihypertensive medication; age 45-75 years; and either no use of antihypertensive medication or unchanged antihypertensive medication in the prior 2 months

Exclusions:

Peak blood pressure on 24-hour ambulatory monitoring >220/115 mm Hg, creatinine >1.5 mg/dl, proteinuria >0.5 g/24 hours, evidence of renal hypertension or hyperthyroidism, diabetes mellitus, atrial fibrillation, at least moderate valvular heart disease, a history of stroke, angina or myocardial infarction, malignant disease, or a life expectancy <6 months

Primary Endpoints:

Average SBP and DBP on 24-hour ambulatory blood pressure monitoring after the treatment course and at 3 and 6 months

Secondary Endpoints:

Average daytime and nighttime SBPs and DBPs and a reduction in blood pressure at peak stress during bicycle stress testing

Drug/Procedures Used:

Patients were randomized to active acupuncture (n = 72) or sham acupuncture (n = 68) for 6 weeks, conducted in 22 sessions lasting 30 minutes. In the sham group, needling was performed in a similar manner to the active treatment group, but the needling points used did not have relevance for blood pressure lowering according to traditional Chinese medicine concepts. Acupuncture was performed by Chinese physicians trained in traditional Chinese medicine.

Principal Findings:

Among the patients randomized, 11 were lost prior to the initiation of treatment and 9 terminated during the study, 2 of whom discontinued due to pain associated with acupuncture. Baseline 24-hour blood pressure was 130/81 mm Hg. Antihypertensive agent was used at study entry in 78% of patients, with no change throughout the study.

At the end of treatment, blood pressure was significantly lower in the active acupuncture group compared with the sham acupuncture group (between-group difference in systolic blood pressure [SBP]/diastolic blood pressure [DBP] 6.4/3.7 mm Hg, p < 0.001). Differences in blood pressure were greatest in the daytime (between-group difference in SBP/DBP 7.3/4.0 mm Hg) and less so at night (between-group difference in SBP/DBP 3.4/1.8 mm Hg). There was no difference in blood pressure between the groups at the 3- and 6-month follow-up, with blood pressures returning to pretreatment levels in the active treatment group.

There were no bleeding, hematoma, perforation, infection, or other complications requiring treatment. The amount of time required for the acupuncture sessions was the most frequent complaint. There were no deaths or coronary complications during the study.

Interpretation:

Among patients with mild or moderate arterial hypertension, active acupuncture therapy was associated with a reduction in blood pressure at the end of treatment compared with sham acupuncture therapy.

Despite reports of the ability of acupuncture using traditional Chinese medicine techniques to lower blood pressure, limited data are available from randomized trials to show such an effect. The present study is the first randomized, controlled trial conducted in Western patients to show that acupuncture was effective in reducing 24-hour ambulatory blood pressures during treatment. It should be noted that the effect of the intervention did not last beyond the active treatment time frame, with no difference in blood pressure at 3 and 6 months between groups, and a return to baseline blood pressure levels in the active acupuncture group following treatment discontinuation.

The mechanism by which acupuncture lowers blood pressure is not known. Additional studies are warranted to validate these findings, which may provide an alternative method of treatment for patients with mild arterial hypertension. These findings should not be extrapolated to patients with more severe hypertension. It should also be noted that the large majority of patients in the trial were also taking antihypertensive medications.

References:

Flachskampf FA, Gallasch J, Gefeller O, et al. Randomized Trial of Acupuncture to Lower Blood Pressure. Circulation. 2007;115:3121-3129.

Clinical Topics: Prevention, Hypertension

Keywords: Outpatients, Blood Pressure, Pain, Hematoma, Medicine, Chinese Traditional, Acupuncture Therapy, Hypertension


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