Heat-sensitive moxibustion self-administration in patients in the community with primary hypertension: A protocol for a multi-center, pragmatic, non-randomized trial

Xu Zhou, Qingni Wu, Gaochuan Zhang, Yanping Wang, Shuqing Li, Baiyang Wang, Zhihua Chen, Weifeng Zhu, Fei Wang, Chun Gan, Xu Zhou, Qingni Wu, Gaochuan Zhang, Yanping Wang, Shuqing Li, Baiyang Wang, Zhihua Chen, Weifeng Zhu, Fei Wang, Chun Gan

Abstract

Background: Although the efficacy of antihypertensive drugs has been well established for primary hypertension, their effectiveness is always limited by side effects and poor compliance. Heat-sensitive moxibustion is an innovative acupoint stimulation therapy that is promising as a community health care intervention for hypertension.

Aims: This study aims to evaluate the pragmatic effectiveness and safety of heat-sensitive moxibustion self-administration by patients in the community with primary hypertension.

Methods: This study will adopt a multi-center, pragmatic, nonrandomized design. Six hundred patients with primary hypertension will be recruited from 4 communities. Each patient will choose to either receive heat-sensitive moxibustion self-administration + original antihypertensive drugs or maintain their original antihypertensive drugs without heat-sensitive moxibustion for 1 year.

Expected outcomes: The primary outcome will be changes in systolic and diastolic blood pressures and the percentage changes in the doses of antihypertensive drugs. The secondary outcomes will be changes in quality of life assessed by a validated patient-reported outcome scale and the levels of fasting blood glucose, glycated hemoglobin, total cholesterol, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, urinary albumin, and serum creatinine. The proportion of patients with poor compliance with the heat-sensitive moxibustion regimen will also be evaluated as a secondary outcome. The safety of heat-sensitive moxibustion will be considered by analyzing the incidence of all and serious adverse events and their correlation with heat-sensitive moxibustion.

Discussion: The findings of this study will provide pragmatic evidence for heat-sensitive moxibustion self-administration in patients in the community with primary hypertension and may also establish an ethical basis for further randomized controlled trials.

Trial registration: The protocol of this trial was registered in ClinicalTrials.gov at May 11, 2020 (No. NCT04381520).

Conflict of interest statement

The authors have no conflicts of interests to disclose.

Figures

Figure 1
Figure 1
Flowchart of the study.
Figure 2
Figure 2
Schedule of study visits. FBG = fasting blood glucose, HbA1c = hemoglobin A1c, TC = total cholesterol, TG = triglycerides, HDL-C = high density lipoprotein cholesterol, LDL-C = low density lipoprotein cholesterol, Scr = serum creatinine.

References

    1. Mills KT, Stefanescu A, He J. The global epidemiology of hypertension. Nat Rev Nephrol 2020;16:223–37..
    1. Ettehad D, Emdin CA, Kiran A, et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet 2016;387:957–67..
    1. Karmali KN, Lloyd-Jones DM, van der Leeuw J, et al. Blood pressure-lowering treatment strategies based on cardiovascular risk versus blood pressure: a meta-analysis of individual participant data. PLoS Med 2018;15:e1002538.
    1. Naderi SH, Bestwick JP, Wald DS. Adherence to drugs that prevent cardiovascular disease: meta-analysis on 376,162 patients. Am J Med 2012;125:882.e881–7.e881..
    1. Butt DA, Mamdani M, Austin PC, et al. The risk of hip fracture after initiating antihypertensive drugs in the elderly. Arch Intern Med 2012;172:1739–44..
    1. Bangalore S, Kumar S, Kjeldsen SE, et al. Antihypertensive drugs and risk of cancer: network meta-analyses and trial sequential analyses of 324,168 participants from randomised trials. Lancet Oncol 2011;12:65–82..
    1. Tan X, Pan Y, Su W, et al. Acupuncture therapy for essential hypertension: a network meta-analysis. Ann Transl Med 2019;7:266.
    1. Deng H, Shen X. The mechanism of moxibustion: ancient theory and modern research. Evid Based Complement Alternat Med 2013;2013:379291.
    1. Shin KM, Park JE, Liu Y, et al. Efficacy of moxibustion for pre- or stage I hypertension: study protocol for a pilot randomized controlled trial. Trials 2012;13:188.
    1. Wang J, Xiong X. Evidence-based Chinese medicine for hypertension. Evid Based Complement Alternat Med 2013;2013:978398.
    1. Shin KM, Park JE, Yook TH, et al. Moxibustion for prehypertension and stage I hypertension: a pilot randomized controlled trial. Integr Med Res 2019;8:1–7..
    1. Xie D, Liu Z, Hou X, et al. Heat sensitisation in suspended moxibustion: features and clinical relevance. Acupunct Med 2013;31:422–4..
    1. Liao F, Zhang C, Bian Z, et al. Characterizing heat-sensitization responses in suspended moxibustion with high-density EEG. Pain Med 2014;15:1272–81..
    1. Xiong J, Liu Z, Chen R, et al. Effectiveness and safety of heat-sensitive moxibustion on bronchial asthma: a meta-analysis of randomized control trials. J Tradit Chin Med 2014;34:392–400..
    1. Chen R, Xiong J, Chi Z, et al. Heat-sensitive moxibustion for lumbar disc herniation: a meta-analysis of randomized controlled trials. J Tradit Chin Med 2012;32:322–8..
    1. Chan AW, Tetzlaff JM, Altman DG, et al. SPIRIT 2013 statement: defining standard protocol items for clinical trials. Ann Intern Med 2013;158:200–7..
    1. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Soc Hypertens 2018;12:579.e571–3..
    1. Guangzhou University of Chinese Medicine, Li Q. The Establishment of PRO Questionnaire Used in the Evaluation of the Clinical Effectiveness of Hypertension in TCM (Chinese) [Master's thesis]. 2014.
    1. Xu J, Deng H, Shen X. Safety of moxibustion: a systematic review of case reports. Evid Based Complement Alternat Med 2014;2014:783704.
    1. Wu J, Hu Y, Zhu Y, et al. Systematic review of adverse effects: a further step towards modernization of acupuncture in China. Evid Based Complement Alternat Med 2015;2015:432467.
    1. Mao Q, Wang H, Zhang F, et al. Preliminary analysis on the construction model of heat-sensitive moxibustion town: take Taibaozhuang subdistrict office of Xiashan district in Weifang city of Shandong province as an example (Chinese). J Jiangxi Uni Trad Chin Med 2019;31:1–5..

Source: PubMed

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