The Hypotensive Role of Acupuncture in Hypertension: Clinical Study and Mechanistic Study

Acupuncture represents a promising alternative for the treatment of arterial hypertension, a condition that affects nearly half of the American adult population and constitutes the leading preventable risk factor for premature death and disability worldwide. With a rising global prevalence, especially among older adults, hypertension causes approximately 9.4 million deaths annually from cardiovascular disease. Although established recommendations exist for blood pressure control, such as lifestyle changes and medication use, many patients struggle with medication side effects or with implementing lasting behavioral modifications. In this context, acupuncture emerges as a longstanding therapeutic technique from traditional Chinese medicine that exhibits a very low incidence of adverse events—only 0.13%—compared with conventional pharmacologic treatments.

The aim of this review was to systematically analyze the scientific evidence on the effects of acupuncture in reducing blood pressure, through both clinical studies and investigations into the underlying mechanisms of action. The investigators conducted a comprehensive analysis of the available literature, examining controlled clinical trials, meta-analyses, and experimental studies in animal models. The methodology included evaluation of different acupuncture protocols, treatment frequency, specific points used, and comparisons with sham treatments or conventional medications. Particular attention was given to studies that investigated the neurobiological mechanisms through which acupuncture exerts its antihypertensive effects, including analyses of afferent and efferent nerve pathways, the central nervous system, and the neurotransmitters involved.

The results consistently demonstrate that acupuncture can significantly reduce blood pressure in hypertensive patients. Clinical studies showed that patients receiving real acupuncture had greater reductions in systolic and diastolic pressure compared with control groups or sham acupuncture, with benefits sustained for prolonged periods after treatment. Meta-analyses confirmed that combining acupuncture with antihypertensive medications produces superior results to medication alone. Investigations into point specificity revealed that certain acupuncture points, such as PC-5–PC-6 and ST-36–ST-37, are particularly effective in reducing blood pressure, whereas control points do not show the same benefits.

Mechanistic studies clarified that acupuncture acts through a complex network of neural pathways, beginning with stimulation of afferent nerve fibers at acupuncture points, which transmit signals to the central nervous system, where specific brain nuclei such as the arcuate nucleus, periaqueductal gray, and rostral ventrolateral medulla process and modulate cardiovascular responses through sympathetic and parasympathetic efferent pathways.

For patients and clinicians, these findings suggest that acupuncture can be considered a safe and effective therapeutic option as complementary treatment for hypertension. Results indicate that acupuncture is especially beneficial when combined with conventional medications, enhancing hypotensive effects and possibly allowing for medication dose reductions. The low incidence of side effects makes acupuncture an attractive alternative for patients who experience adverse reactions to medications or who seek more natural therapeutic approaches. For clinicians, it is important to understand that acupuncture efficacy depends on appropriate point selection, suitable treatment frequency, and the qualifications of the acupuncturist.

The identified neurobiological mechanisms provide a solid scientific basis for the use of acupuncture, helping demystify this longstanding practice and integrate it more effectively into modern treatment protocols.

Despite the promising results, the study acknowledges important limitations that must be considered. Some clinical trials, such as the SHARP program conducted in the United States, did not demonstrate significant differences between real and sham acupuncture, possibly due to inadequate treatment frequency. Variability in acupuncture protocols used across studies hinders direct comparisons and the establishment of standardized guidelines. It remains unclear whether different acupuncture points activate specific neural pathways or whether points on different meridians produce differential effects.

Most mechanistic studies have been conducted in animal models, and more human studies are needed to confirm the proposed mechanisms. Additionally, more rigorous investigations are needed to determine optimal treatment protocols, including frequency, duration, and selection of the most effective points for different hypertensive patient profiles. Future research should also explore the sustainability of long-term benefits and identify patient characteristics that may predict better response to acupuncture treatment.