Acupuncture for hypertension

This Cochrane systematic review represents the most comprehensive and rigorous analysis of acupuncture for the treatment of primary hypertension. The investigators analyzed 22 randomized controlled trials involving 1,744 participants to determine whether acupuncture can offer sustained benefits for elevated blood pressure control. The methodology followed the rigorous standards of the Cochrane Collaboration, including systematic searches of multiple databases, critical risk-of-bias appraisal, and appropriate statistical analysis. The included studies compared true acupuncture with sham (simulated) controls or conventional antihypertensive medications.

The methodological quality of the included studies was variable, with most showing a high risk of bias due to the inherent difficulty of blinding participants and providers in acupuncture trials. Only four studies used adequate sham controls, considered the gold standard for evaluating the specific efficacy of acupuncture. The principal results revealed a concerning absence of evidence for sustained acupuncture effects on blood pressure. Only one study investigated long-term effects and found no blood pressure reduction at three and six months after treatment.

In studies with adequate sham control, a statistically significant but clinically questionable reduction of 3.4 mmHg in systolic and 1.9 mmHg in diastolic blood pressure was observed, limited to a window of 1 to 24 hours after the sessions. This modest reduction is insufficient to justify the use of acupuncture as a primary or adjunctive treatment for hypertension. Studies comparing acupuncture with antihypertensive medications showed apparently larger benefits, but the investigators attributed these results to high risk of bias rather than to a true therapeutic effect. The safety of acupuncture could not be adequately assessed because only eight of the 22 studies reported adverse events.

Reported events were predominantly minor, including local pain and small bleeds, although one case of a hypertensive emergency was reported. Clinical heterogeneity among the studies was substantial, with significant variations in acupuncture points used, session frequency, treatment duration, and participant characteristics. The clinical implications of this review are clear: at present there is no robust scientific evidence to recommend acupuncture for the treatment of chronic hypertension. For acupuncture to be considered a valid therapeutic option for hypertension, sustained effects would need to be demonstrated for at least one week, preferably one month — which was not observed in the studies analyzed.

The authors emphasize that future research should focus on investigating durable effects using appropriate sham controls.