Long-Lasting Reduction of Blood Pressure by Electroacupuncture in Patients with Hypertension: Randomized Controlled Trial

Peng Li, Stephanie C Tjen-A-Looi, Ling Cheng, Dongmei Liu, Jeannette Painovich, Sivarama Vinjamury, John C Longhurst, Peng Li, Stephanie C Tjen-A-Looi, Ling Cheng, Dongmei Liu, Jeannette Painovich, Sivarama Vinjamury, John C Longhurst

Abstract

Background: Acupuncture at specific acupoints has experimentally been found to reduce chronically elevated blood pressure. Objective: To examine effectiveness of electroacupuncture (EA) at select acupoints to reduce systolic blood pressure (SBP) and diastolic blood pressures (DBP) in hypertensive patients. Design: Two-arm parallel study. Patients: Sixty-five hypertensive patients not receiving medication were assigned randomly to one of the two acupuncture intervention (33 versus 32 patients). Intervention: Patients were assessed with 24-hour ambulatory blood pressure monitoring. They were treated with 30-minutes of EA at PC 5-6+ST 36-37 or LI 6-7+GB 37-39 once weekly for 8 weeks. Four acupuncturists provided single-blinded treatment. Main outcome measures: Primary outcomes measuring effectiveness of EA were peak and average SBP and DBP. Secondary outcomes examined underlying mechanisms of acupuncture with plasma norepinephrine, renin, and aldosterone before and after 8 weeks of treatment. Outcomes were obtained by double-blinded evaluation. Results: After 8 weeks, 33 patients treated with EA at PC 5-6+ST 36-37 had decreased peak and average SBP and DBP, compared with 32 patients treated with EA at LI 6-7+GB 37-39 control acupoints. Changes in blood pressures significantly differed between the two patient groups. In 14 patients, a long-lasting blood pressure-lowering acupuncture effect was observed for an additional 4 weeks of EA at PC 5-6+ST 36-37. After treatment, the plasma concentration of norepinephrine, which was initially elevated, was decreased by 41%; likewise, renin was decreased by 67% and aldosterone by 22%. Conclusions: EA at select acupoints reduces blood pressure. Sympathetic and renin-aldosterone systems were likely related to the long-lasting EA actions.

Trial registration: ClinicalTrials.gov NCT00932139.

Keywords: Neiguan-Jianshi and Zusanli-Shangjuxu; Pianli-Wenliu and Guanming-Xuanzhong; Point Specificity.

Figures

FIG. 1.
FIG. 1.
Flow diagram of patients screened, enrolled, and assigned to different protocols. BP, blood pressure; CV, cardiovascular; DBP, diastolic blood pressure; EA, electroacupuncture; HTN, hypertension; IRB, institutional review board; UCI, University of California, Irvine.
FIG. 2.
FIG. 2.
Blood pressures (BPs) averaged over 24 hours and heart rate in 33 hypertensive patients treated with electroacupuncture (EA) at PC 5-6+ST 36-37 active acupoints for 8 weeks. Systolic (A), diastolic (B), and mean (C) BPs were reduced. EA did not alter heart rate (D). BP was significantly reduced after 4 weeks of treatment. DBP, diastolic blood pressure; HR, heart rate; MBP, mean blood pressure; SBP, systolic blood pressure. *Significant difference compared to pre-acupuncture (P<0.05). Bracket indicates standard error.
FIG. 3.
FIG. 3.
Electroacupuncture (EA) at LI 6-7+GB 37-39 acupoints did not consistently alter blood pressure or heart rate in 32 patients. Systolic (A), diastolic (B) and mean (C) blood pressures and heart rates (D) after 8 weeks of EA applied at LI 6-7+GB 37-39 acupoints were not different from values at onset of study. DBP, diastolic blood pressure; HR, heart rate; MBP, mean blood pressure; SBP, systolic blood pressure.
FIG. 4.
FIG. 4.
Effects of electroacupuncture (EA) at PC 5-6+ST 36-37 and LI 6-7+GB 37-39 were evaluated in a crossover study. Seventeen patients were randomly treated with EA at PC 5-6+ST 36-37 or LI 6-7+GB 37-39 acupoints for 8 weeks, followed by a recovery period of 2 weeks. Patients then were treated for 8 weeks by applying EA to the other sets of acupoints. The patients respond differentially to stimulation of the two sets of acupoints, confirming point-specific actions of EA on cardiovascular function. (A) Systolic blood pressure (SBP). (B) Diastolic blood pressure (DBP).
FIG. 5.
FIG. 5.
Effects of electroacupuncture (EA) were evaluated for 2 months in the follow-up study in 21 patients. Peak and average systolic blood pressure (SBP) was reduced for 1 month after EA (PC 5-6+ST 36-37). Peak and average SBPs were reduced at weeks 6 and 8 (A1). While average DBP was reduced at weeks 6 and 8 (A2) during EA. EA at LI 6-7+GB 37-39 acupoints did not consistently decrease blood pressure (B1 and B2). Eight weeks after termination of EA, blood pressures had returned to pretreatment control levels. DBP, diastolic blood pressure.
FIG. 6.
FIG. 6.
Group comparison of the changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP) at 2, 4, 6, and 8 weeks with electroacupuncture (EA) treatment at active and control acupoints. The changes in SBP were different at week 8 in the two groups of patients with treatment at PC 5-6+ST 36-37 and LI 6-7+GB 36-37 (A). EA treatment at PC 5-6+ST 36-37 acupoints for 8 weeks decreased average DBP compared with control treatment (B).
FIG. 7.
FIG. 7.
Electroacupuncture (EA) modulation of plasma norepinephrine. Norepinephrine in 25 hypertensive patients was measured before and after 8 weeks of treatment with EA at PC 5-6+ST 36-37. EA did not influence epinephrine. Baseline norepinephrine was higher before EA (**P<0.05) and decreased by 164 ng/mL in patients responsive to EA (*P<0.05). Norepinephrine was not altered by 8 weeks of EA treatment in 12 patients unresponsive to EA.
FIG. 8.
FIG. 8.
Electroacupuncture (EA) modulation of plasma renin activity. Renin activity in 13 of 22 hypertensive patients responsive to EA at PC 5-6+ST 36-37 was decreased significantly after 8 weeks of treatment. Nine low responders with lower renin activities before EA were unchanged by 8 weeks of therapy.
FIG. 9.
FIG. 9.
Action of electroacupuncture over a 6-month period assessed during monthly reinforcement therapy in a subgroup of 7 hypertensive patients. After 8 weeks of weekly EA, continued monthly EA treatment maintained a low systolic blood pressure (SBP) relative to pre-EA control.

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