Efficacy of acupuncture for hypertension in the elderly: a systematic review and meta-analysis
Wang et al. · Frontiers in Cardiovascular Medicine · 2023
Evidence Level
MODERATEOBJECTIVE
Evaluate the efficacy of acupuncture alone or combined with antihypertensive medications to reduce blood pressure in older adults
WHO
Older adults ≥60 years with hypertension (SBP ≥140 or DBP ≥90 mmHg)
DURATION
Treatments of 1 to 12 weeks, frequency of 1 to 7 times per week
POINTS
Quchi (most used), followed by Sanyinjiao, Baihui, Hegu, and Zusanli
🔬 Study Design
Acupuncture alone
n=420
Traditional acupuncture or electroacupuncture
Acupuncture + medications
n=954
Acupuncture combined with antihypertensives
Medications alone
n=1466
Standard pharmacologic therapy
📊 Results in numbers
Efficacy rate — acupuncture vs medications
Efficacy rate — acupuncture+medications vs medications
SBP reduction with combined therapy
DBP reduction with combined therapy
📊 Outcome Comparison
Treatment efficacy rate (%)
This study shows that acupuncture is a safe and effective option for older adults with high blood pressure. When used alone, acupuncture has efficacy similar to traditional medications, and when combined with medications, the results are even better. Less frequent treatments over longer periods tend to be more effective.
Article summary
Plain-language narrative summary
This meta-analysis represents the first systematic study focused specifically on the efficacy of acupuncture for hypertension in older patients, analyzing 12 randomized clinical trials that included 1,466 participants aged 60 years or older. The study was conducted following rigorous PRISMA guidelines and registered with PROSPERO, with searches across seven databases through November 2022. Hypertension in older adults has unique features, including a predominance of systolic blood pressure elevation, greater blood pressure variability, and increased susceptibility to medication adverse effects, making it essential to investigate safe complementary therapies. The researchers evaluated both acupuncture alone and its combination with antihypertensive medications, comparing them with standard pharmacologic treatment.
Primary outcomes included efficacy rate (defined as a reduction of ≥10 mmHg in systolic blood pressure or ≥5 mmHg in diastolic blood pressure) and changes in blood pressure values. Methodologic quality was assessed using Cochrane tools, revealing limitations in aspects such as allocation concealment and blinding, common in acupuncture studies. The main analysis demonstrated that acupuncture alone had efficacy similar to medications (RR=1.11, 95% CI: 1.03–1.20), while combined therapy was superior to medications alone (RR=1.18, 95% CI: 1.06–1.31). In subgroup analyses, treatments with a frequency of less than three times per week and a duration longer than four weeks showed greater efficacy.
The most used acupuncture points were Quchi (arm), Sanyinjiao (leg), Baihui (head), Hegu (hand), and Zusanli (leg), reflecting traditional Chinese medicine approaches to cardiovascular regulation. Combined therapy showed significant reductions in both systolic (−9.81 mmHg) and diastolic (−7.04 mmHg) blood pressure. Proposed mechanisms include modulation of the sympathetic nervous system, regulation of the renin-angiotensin-aldosterone axis, and effects on neurotransmitters such as serotonin and norepinephrine. The study has important implications for clinical practice, suggesting that older adults with inadequate response to or adverse effects from antihypertensives may benefit from adjunctive acupuncture.
However, limitations include heterogeneity of acupuncture protocols, variable methodologic quality of the included studies, and the fact that all trials were conducted in China, limiting generalizability of the findings. The absence of long-term safety data and major cardiovascular outcomes also represents an important gap.
Strengths
- 1First study focused specifically on older adults with hypertension
- 2Detailed subgroup analysis by treatment frequency and duration
- 3Rigorous methodology following PRISMA guidelines
- 4Robust sample of 1,466 participants
- 5Evaluation of both efficacy and absolute blood pressure changes
Limitations
- 1Variable methodologic quality of the included studies
- 2All studies conducted in China, limiting generalizability
- 3Heterogeneity in the acupuncture protocols used
- 4Absence of long-term safety data
- 5Lack of evaluation of major cardiovascular outcomes
Expert Commentary
Dr. Marcus Yu Bin Pai
MD, PhD · Pain Medicine · Physical Medicine and Rehabilitation · Medical Acupuncture
▸ Clinical Relevance
Hypertension in older adults presents a distinct clinical scenario: predominance of isolated systolic elevation, greater circadian blood pressure variability, and a narrow pharmacologic therapeutic window that often forces us to use submaximal doses to avoid orthostatic hypotension, dizziness, and falls. It is precisely in this group that an adjunctive intervention with a favorable safety profile gains real value. This meta-analysis of 1,466 participants shows that acupuncture combined with standard pharmacologic therapy reduces systolic blood pressure by about 10 mmHg and diastolic by 7 mmHg — magnitudes that, in older adults, translate into measurable reductions in cardiovascular risk. The finding that a session frequency below three times per week is associated with greater efficacy has direct logistical implications for older adults with reduced mobility or dependence on transportation, making treatment feasible in real-world outpatient settings.
▸ Notable Findings
The finding that warrants genuine clinical attention is the superiority of combined therapy over pharmacologic treatment alone, expressed by an RR of 1.18 — not equivalence but a real increment in efficacy. The proposed mechanisms converge on sympathetic modulation and influence on the renin-angiotensin-aldosterone axis, which is biologically coherent with what we know about the neural pathways activated by needling at points such as Quchi and Zusanli. Another important point comes from the subgroup analysis: a duration longer than four weeks was associated with greater efficacy, suggesting that the antihypertensive effect of acupuncture is cumulative and time-dependent rather than immediate. This changes the expected outcome and reinforces the need for a structured protocol, not isolated single sessions, to achieve sustained blood pressure benefit in this population.
▸ From My Experience
In my practice with elderly hypertensive patients — many of them referred by cardiology or internal medicine after limitations in pharmacologic titration — I typically observe a perceptible blood pressure response from the third or fourth week of treatment, which is consistent with the subgroup of longer than four weeks in this meta-analysis. I usually work with weekly or twice-weekly sessions in this age group, which facilitates adherence and coincides with the frequency of less than three times per week identified as more effective. I commonly combine needling with light physical activity guidance and, when there is a clear anxiety component, complementary autonomic regulation techniques. The patient profile that responds best, in my experience, is one with stage 1 or 2 hypertension poorly controlled on monotherapy, without advanced target-organ damage. Patients with hypertension that is difficult to control due to hyperaldosteronism or renal artery stenosis are not candidates for this approach as primary intervention.
Full original article
Read the full scientific study
Frontiers in Cardiovascular Medicine · 2023
DOI: 10.3389/fcvm.2023.1147135
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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