Educacion En La Vidaa

articles

nature publishing group

Acupuncture for Lowering Blood Pressure:
Systematic Review and Meta-analysis
Hyangsook Lee1,2, Song-Yi Kim1,3, Jongbae Park1,4, Yun-ju Kim3,5, Hyejung Lee1,3 and Hi-Joon Park1,3
Background
We conducted a systematic review to estimate the effect of
acupuncture on blood pressure (BP) in hypertensive patients.
Methods
Electronic literature searches forrandomized controlled trials (rCTs)
of acupuncture were performed in six electronic databases to june
2007 without language restrictions.
results
Eleven rCTs testing acupuncture either as an adjunct or an
alternative met our inclusion criteria and they showed a wide variety
of methodological quality, mainly due to poor reporting. Three
sham-controlled trials out of 11 studies werestatistically pooled:
systolic BP (SBP) change was not statistically significant (mean
difference −5 mm Hg, 95% CI (−12, 1), P = 0.12) and acupuncture only
marginally reduced diastolic BP (DBP) by 3 mm Hg (95% CI (−6, 0), P =
0.05), but substantial heterogeneity was observed (I2 = 92% for SBP,

IntroductIon

Approximately one-half of the patients with high blood pressure (BP) are not compliant withdrug therapy for various
reasons including treatment cost, adverse effects, and complications.1 Perhaps, for this reason, there has been a growing
interest in acupuncture for lowering BP.2 Acupuncture has
long been used for controlling hypertension-related symptoms. Over the past two decades there has been increased
understanding of biological mechanisms underlying acupuncture effects. Theeffects of acupuncture on the cardiovascular
system has been reported as the results of the excitation of
somatic afferent input, activating sympathetic inhibitory systems in the brain related to endogenous opioids, nociceptin,
γ-aminobutyric acid, and serotonin.3 Several studies have
also demonstrated that acupuncture changed the level of BP

I2 = 79% for DBP). When given with antihypertensivemedication,
acupuncture significantly reduced SBP (−8 mm Hg, 95% CI (−10,
−5), P < 0.00001) and DBP (−4 mm Hg, 95% CI (−6, −2), P < 0.0001)
and no heterogeneity between studies was detected. Four studies
that investigated acupuncture against antihypertensive medication
indicated noninferiority of acupuncture in lowering BP, albeit the
quality of them was poor, and their sample sizes werenot satisfactory
as an equivalence study. Other studies comparing acupuncture with
various control procedures had inconsistent findings and most of
them were of low methodological quality.
conclusIons
Considering the limitation of the four positive noninferiority
studies and the results of the meta-analysis of the three shamcontrolled studies, the notion that acupuncture may lower high BP isinconclusive. More rigorous trials are warranted.
Am J Hypertens 2009; 22:122-128 © 2009 American Journal of Hypertension, Ltd.

modulators such as endothelin-1,4 renin,5 aldosterone,6 and
angiotension II7 in hypertensive patients. Meanwhile, clinical
trials investigating the efficacy of acupuncture on hypertension have reported conflicting results, yet two reviews supported the use ofacupuncture for hypertension.8,9 Because
the previous reviews were not performed systematically,
they might have left out some important studies, and new
high-quality randomized controlled trials (RCTs) have been
recently published.10,11 Therefore, we decided to conduct a
systematic review and a partial meta-analysis on the efficacy
of acupuncture for lowering BP. The aim of this review was tosystematically summarize and evaluate the effect of acupuncture based on the currently available evidence on lowering BP
in the patients with hypertension.
Methods

1acupuncture and Meridian Science research Center (aMSrC), Kyung Hee

university, Seoul, South Korea; 2Department of Meridian and acupoint, College
of Korean Medicine, Sangji university, Kangwondo, South Korea; 3Department
of...