Acupuncture, a promising adjunctive therapy for essential hypertension: a double-blind, randomized, controlled trial
Yin et al. · Neurological Research · 2007
Evidence Level
MODERATEOBJECTIVE
To assess the efficacy of acupuncture as adjunctive therapy in the treatment of essential hypertension
WHO
41 Korean volunteers with hypertension or prehypertension
DURATION
8 weeks with 17 acupuncture sessions
POINTS
ST-36, LI-11, BL-25, SP-3, LU-9, BL-13, KI-7, KI-2, CV-4, LI-1, GV-14, GB-20, PC-6, HT-7
🔬 Study Design
True Acupuncture
n=15
True acupuncture with needle insertion
Sham Acupuncture
n=15
Placebo acupuncture without skin penetration
📊 Results in numbers
Systolic BP reduction (acupuncture group)
Diastolic BP reduction (acupuncture group)
Statistical significance
Adverse effects
Percentage highlights
📊 Outcome Comparison
Systolic BP reduction after 8 weeks
Diastolic BP reduction after 8 weeks
This study showed that acupuncture may be an effective complementary therapy for people with high blood pressure. When used together with antihypertensive medications, acupuncture significantly reduced blood pressure compared with placebo treatment, with few side effects.
Article summary
Plain-language narrative summary
This randomized, double-blind, placebo-controlled study investigated the efficacy of acupuncture as adjunctive therapy in the treatment of essential hypertension. The research was conducted at Kyung Hee University Hospital in South Korea between January and May 2004, with 41 Korean volunteers with hypertension or prehypertension initially recruited. Arterial hypertension affects approximately one billion people worldwide and represents a significant independent risk factor for myocardial infarction, heart failure, stroke, and kidney disease. Conventional management of hypertension often presents challenges, including poor medication adherence and adverse effects, resulting in inadequate control rates.
Acupuncture has traditionally been used in East Asia, and its acceptance in the West has progressively increased. Proposed mechanisms for the cardiovascular effects of acupuncture include modulation of the autonomic nervous system, particularly through reduction of sympathetic nervous system activation via cholinergic system activation and opioid receptors in the rostral ventrolateral medulla. The methodological design included inclusion criteria for volunteers with systolic pressure greater than 120 mmHg or diastolic pressure greater than 80 mmHg. Participants with systolic pressure greater than 140 mmHg or diastolic pressure greater than 90 mmHg were included only if already on antihypertensive medication.
The control method employed was the Park sham needle, a non-penetrating device that simulates the actual acupuncture procedure. The acupuncture protocols were based on the Saam theory of Korean acupuncture, with four prespecified formulas: tonification of the large intestine meridian (ST-36, LI-11, BL-25), lung (SP-3, LU-9, BL-13), kidney (KI-7, KI-2, CV-4), or bladder (LI-1, GV-14, GB-20). Optionally, PC-6 and HT-7 were added when psychological factors were considered important. Of the 41 initial participants, 30 completed the 8-week protocol, all on antihypertensive medication.
Randomization was successful, with no significant differences in baseline characteristics between groups. The true acupuncture group demonstrated a significant reduction (p < 0.01) in mean blood pressure from 136.8/83.7 mmHg to 122.1/76.8 mmHg after 8 weeks of intervention. In contrast, the sham group showed no significant changes in blood pressure. The temporal difference in systolic and diastolic blood pressure changes between groups was statistically significant (p < 0.05) during the second half of the intervention.
Other parameters evaluated included general health, pain, and treatment satisfaction/expectation scales. The true acupuncture group showed improvement on the general health scale throughout the intervention period, whereas the sham group improved only in the second half. The pain scale decreased significantly only in the true acupuncture group. The satisfaction/expectation scale increased only in the true group during the second half of the intervention, corresponding to the period of greatest antihypertensive effect.
Adverse effects were minimal, with point bleeding observed in only 5% of true acupuncture sessions, occurring in eight participants with a mean of 1.6 episodes per person. Blinding was successfully maintained, with no need to exclude participants for discovering the sham nature of the treatment. Adherence to complementary breathing and walking exercises was high in both groups. Limitations of the study include the relatively small sample size, follow-up period limited to 8 weeks, and possible performance bias.
The 27% dropout rate also represents a limitation, although it was similar across groups. The results suggest that acupuncture may offer significant additional benefits in the treatment of hypertensive patients when used as adjunctive therapy to conventional medication. This finding is particularly relevant considering that hypertension is an important risk factor for major cardiovascular events.
Strengths
- 1Double-blind design with appropriate sham control using the Park non-penetrating needle
- 2Protocol based on a well-established traditional Korean acupuncture theory
- 3Objective blood pressure measurements with standardized methods
- 4High adherence to the protocol and maintenance of blinding
Limitations
- 1Small sample size (n = 30) limiting statistical power
- 2Short follow-up period (8 weeks) with no long-term data
- 327% dropout rate that may introduce selection bias
- 4All participants were Korean, limiting generalizability to other populations
Expert Commentary
Dr. Marcus Yu Bin Pai
MD, PhD · Pain Medicine · Physical Medicine and Rehabilitation · Medical Acupuncture
▸ Clinical Relevance
Poorly controlled essential hypertension represents one of the greatest challenges in contemporary cardiovascular medicine, and any adjunctive intervention with a favorable safety profile deserves serious clinical attention. This trial demonstrates that acupuncture combined with conventional drug therapy can reduce systolic pressure by 14.8 mmHg and diastolic by 6.9 mmHg in 8 weeks — a clinically meaningful magnitude, given that reductions of this order directly affect the risk of major cardiovascular events. The most immediate application scenario is the hypertensive patient on antihypertensives who has not reached the blood pressure goal, especially those with poor tolerance to drug escalation due to adverse effects. The safety profile was excellent, with point bleeding in only 5% of sessions, reinforcing the feasibility of integrating this approach into the outpatient protocol of cardiology and internal medicine.
▸ Notable Findings
The most methodologically robust aspect of this work is the use of the Park sham needle, which preserves patient blinding by simulating the tactile experience of acupuncture without skin penetration — a control rarely well-executed in the cardiovascular acupuncture literature. The antihypertensive effect was concentrated in the second half of the protocol, with the between-group difference reaching statistical significance (p < 0.05) from that point on, which is neurophysiologically consistent with the time required for sustained autonomic modulation via the cholinergic system and opioid receptors in the rostral ventrolateral medulla. The parallel improvement on the pain and general health scales exclusively in the true acupuncture group suggests a systemic effect that goes beyond isolated blood pressure reduction. The protocol based on Korean Saam theory, with formulas structured by meridian pattern, gives reproducibility to the scheme used, distinguishing this trial from protocols with individualized ad hoc points.
▸ From My Experience
In my practice in rehabilitation and pain medicine, I have been following patients with hypertensive comorbidity for decades, and the blood pressure response to acupuncture that I routinely observe is consistent with what this article documents: the change is rarely immediate; I usually see the first signs of response after the fourth or fifth session, with more evident stabilization between the sixth and eighth. I habitually combine acupuncture with supervised aerobic exercise — walking or stationary cycling — and, when there is a relevant autonomic stress component, I add breathing regulation techniques, exactly as the authors incorporated into the protocol. In my experience, the patient profile that responds best is one with stage 1 or 2 hypertension and an evident component of sympathetic hyperactivity — relative tachycardia, blood pressure variability throughout the day. I do not indicate acupuncture as monotherapy under any circumstance; the value lies precisely in adjunctive use, as this trial positions it well.
Full original article
Read the full scientific study
Neurological Research · 2007
DOI: 10.1179/016164107X172220
Access original articleScientific Review
Marcus Yu Bin Pai, MD, PhD
CRM-SP: 158074 | RQE: 65523 · 65524 · 655241
PhD in Health Sciences, University of São Paulo. Board-certified in Pain Medicine, Physical Medicine and Rehabilitation, and Medical Acupuncture. Scientific review and curation of every entry in this library.
Learn more about the author →Medical disclaimer: This content is for educational purposes only and does not replace consultation, diagnosis, or treatment by a qualified professional. Some information may be assisted by artificial intelligence and is subject to inaccuracies. Always consult a physician.
Content reviewed by the medical team at CEIMEC — Integrated Centre for Chinese Medicine Studies, a reference in Medical Acupuncture for over 30 years.
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