Acupuncture for essential hypertension

This systematic review and meta-analysis evaluated the available scientific evidence on the use of acupuncture in the treatment of essential arterial hypertension. The researchers analyzed 35 randomized controlled trials involving 2,539 patients, published through January 2013, to determine whether acupuncture can be an effective therapy for reducing blood pressure. Arterial hypertension is one of the leading risk factors for cardiovascular disease and stroke, affecting approximately 29% of the adult population worldwide. Although effective medications exist for treatment, many patients experience side effects, high costs, and adherence problems, leading to the search for complementary therapies such as acupuncture.

Acupuncture is based on the traditional Chinese medicine theory that there are energy channels (meridians) in the body, and imbalance of this energy can cause disease. Methodologically, the researchers searched for studies in multiple databases, including PubMed, EMBASE, and Chinese databases. Only randomized controlled trials comparing acupuncture with conventional medications, sham acupuncture, or lifestyle changes were included. The methodological quality of the studies was evaluated using standard Cochrane criteria.

Treatments ranged from 10 to 30 minutes per session, lasting an average of 32 days. The most commonly used acupuncture points included HeGu (LI-4), TaiChong (LR-3), FengChi (GB-20), QuChi (LI-11), and BaiHui (GV-20). The results showed that when acupuncture was combined with antihypertensive medication and compared with medication alone, there was significant reduction in both systolic and diastolic blood pressure. The most consistent finding was observed when acupuncture was compared with sham acupuncture in combination with conventional medication, showing reductions of 7.47 mmHg in systolic and 4.22 mmHg in diastolic blood pressure, with high statistical significance.

Some studies also suggested possible mechanisms of action, including decreased levels of renin, aldosterone, and angiotensin II, as well as alterations in noradrenaline, serotonin, and endorphin levels. Only five studies reported adverse events, which were generally mild, including mild pain at the needle insertion site and minor bleeding. However, the review identified several important limitations. The overall methodological quality of the studies was considered low.

Only eight studies adequately described the randomization method, and only four mentioned allocation concealment. No study was double-blind, which is understandable given the nature of the intervention. Heterogeneity among studies was substantial due to differences in acupuncture points used, treatment duration, diagnostic criteria, and study populations. Furthermore, most studies were conducted in China and published in Chinese, raising concerns about publication bias.

The authors concluded that, although some evidence suggests potential efficacy of acupuncture for hypertension, the results were limited by methodological flaws in the studies. Clinical implications include the recognition that acupuncture may be a useful adjuvant therapy in the management of hypertension, especially for patients seeking alternatives to conventional medications due to side effects or personal preferences. However, the authors emphasized that future studies with better methodological quality, greater rigor in controlling biases, adequate sample sizes, and long-term follow-up are needed to definitively establish the efficacy and safety of acupuncture in the treatment of essential arterial hypertension.