MD, PhD, FMedSci, FSB, FRCP, FRCPEd

This study created a media storm when it was first published. Several articles in the lay press seemed to advertise it as though a true breakthrough had been made in the treatment of hypertension. I would not be surprised, if many patients consequently threw their anti-hypertensives over board and queued up at their local acupuncturist.

Good for business, no doubt – but would this be a wise decision?

The aim of this clinical trial was to examine effectiveness of electroacupuncture (EA) for reducing systolic blood pressure (SBP) and diastolic blood pressures (DBP) in hypertensive patients. Sixty-five hypertensive patients not receiving medication were assigned randomly to one of two acupuncture intervention. Patients were assessed with 24-hour ambulatory blood pressure monitoring. They were treated by 4 acupuncturists with 30-minutes of EA at PC 5-6+ST 36-37 or LI 6-7+GB 37-39 (control group) once weekly for 8 weeks. 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 blinded evaluators.

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%.

The authors concluded that EA at select acupoints reduces blood pressure. Sympathetic and renin-aldosterone systems were likely related to the long-lasting EA actions.

These results are baffling, to say the least; and they contradict a recent meta-analysis which did not find that acupuncture without antihypertensive medications significantly improves blood pressure in those hypertensive patients.

So, who is right and who is wrong here?

Or shall we just look for alternative explanations of the effects observed in the new study?

There could be dozens of reasons for these findings that are unrelated to the alleged effects of acupuncture. For instance, they could be due to life-style changes suggested to the experimental but not the control group, or they might be caused by some other undisclosed bias or confounding. At the very minimum, we should insist on an independent replication of this trial.

It would be silly, I think, to trust these results and now recommend acupuncture to the millions of hypertensive patients worldwide, particularly as dozens of safe, cheap and very effective treatments for hypertension do already exist.

16 Responses to Acupuncture for hypertension? I am not convinced

  • Well, to state the obvious, this tiny clinical trial isn’t testing acupuncture at all. It is testing electrostimulation. That they use needles for electrodes is really beside the point. The trial seems to me practically worthless but it would have been less so if they had done a blinded random comparison between needles with and without current applied and a comparison between needle (invasive) electrodes and gel-electrodes that do not need to break the skin.
    Glancing through the paper I get the familiar feeling that this trial was meant to support the author’s prior reverent beliefs in the theatrical placebo called acupuncture.

    Apart from the study being underpowered the paper is so full of inconsistencies and fallacies that it is a wonder it passed peer review. Or did it??
    To take an example. The abstract states:

    Acupuncture at specific acupoints has experimentally been found to reduce chronically elevated blood pressure

    And then, in the introduction they contradict their own prior statement:

    Several studies have evaluated the BP-lowering actions of acupuncture in patients with hypertension, but their findings are inconclusive.

    This is plainly disingenuous .

    They are comparing two localisations of electrostimulation without really giving any sensible explanation why one ought to be better than the other or how they were chosen.
    For all I know, they might have stumbled upon an anatomic area with one of them, where electric current affects some kind of receptors which in turn affect the autonomic nervous system…? – Something akin to the Carotid body but in the arm.
    Great!! Nobel prize simply waiting around the corner but they are n-content with twaddling on about silly nonsense like “gallbladder”, “stomach” and “pericardial” meridians that have no basis in anatomy or physiology and were invented out of imagination when reinventing blood-letting techniques into pseudotherapy in the early part of the last century.

    Sigh. there ought to be laws against… 🙁

    • Bjorn, are you claiming that the modern-day concept of the acupuncture meridians is based only on bloodletting techniques from the past? The book you link to is no doubt interesting, but it offers nothing more than a snapshot from a specific area and time, from the perspective of one man – aren’t you lot always dismissing anecdotal evidence as meaningless? Chinese Medicine has a rich and complex history dating back to the ancient Neijing text (containing incredibly detailed anatomical descriptions which are the basis for the modern day meridian pathways) and beyond. To suggest it’s nothing but superstition and nonsense is to close your mind to all kinds of wisdom that has the potential to relieve suffering. Did you know the Nobel prize in Medicine was just awarded in part to a Dr directly inspired by Chinese Medicine? http://mobile.nytimes.com/2015/10/06/science/william-c-campbell-satoshi-omura-youyou-tu-nobel-prize-physiology-medicine.html?referer=http://m.facebook.com

      • @Tom

        You ask three questions. The answers are:

        1. Yes, plenty of evidence for that
        2. Anecdotal evidence can be useful for developing ideas and hypothesis but does not prove anything. Even if the meridians had significant anatomical relations, which they do not, it still does not mean that acupuncture works beyond a placebo effect. By the way, which “system” are you referring to, there are so many fantasy based versions that the whole body is covered in points, apart from the genitals 😉

        3. Fine. But that has nothing to do with acupuncture and says nothing about the validity of “Chinese Medicine”

        • 1) And the Neijing? This is 2000 years old, and although it mentions bloodletting, that is just one small component of a vastly complex text – so your suggestion is grossly inaccurate.
          2) I’ve seen anecdotes routinely dismissed on this site (even in this thread). This anecdote seems to back up your own world view, which is I suspect why you are happy to use it. There is a lot of interesting work going on which suggests a strong correlation between the original channel pathways and the course of blood vessels, fascial planes etc. I agree there are multiple problems within the multi-faceted world of acupuncture, but that doesn’t mean it contains nothing of value.
          3) My point was that great things can come from a healthy respect for traditional medicine, and an open, enquiring mind.

          • @Tom
            I respect your faith and determination and I highly applaud your communicating your thoughts under true identity.
            I hope however you understand that I cannot but respectfully declare that you are simply not making any sense.

            On one hand you want us to believe that a ~ 2000 year old book of pre-scientific “medical” texts, contains information about useful medical utilities. What is described and discussed in these texts, which I understand can be found in multiple versions and translations, some of which highly adapted to suit modern ideas and interests, is not so different from that which passed as “medical” practice in the rest of the world at that time, including the deadly delusion of blood-letting. This you want us to take as evidence of the utility of modern applications of “TCM”??

            On the other hand you contradict yourself in suggesting that we dismiss confirmable ≤100 year old documented historical evidence, as (useless?) anecdotes. I take it that the source you refer to is Dugald Christie’s memoirs from thirty years in Manchuria at the end of the nineteenth century. To me that book, which is available online as facsimile of the original publication from 1914, is irrefutable historical evidence, not anecdote(s) in the meaning we put into the term. His book is not the only admissible evidence for the (true) history of acupuncture. I suggest you have a look at the names Ben Kavoussi and Paul Unschuld and what they have to say about this. Of course you can still choose to believe that Dr. Christie was telling tall tales but what is there to say that the author of “the yellow emperor” wasn’t? I find it much more likely that the “holy bible of TCM” was the result of florid imagination. The complexity of that ancient opus is to me a sign of obfuscation and delusion rather than utilitarian wisdom. I have actually tried reading parts of this strange text. The only enlightenment resulting, was that of a firm conviction that the bloke(s) who wrote it must have had not only a psychedelically productive fantasy but not one blinking idea about the true construction or function of the human body. This notion is in part confirmed by Dugald Christies observations of the traditional techniques of torture called Chinese Medicine before its reinvention into products acceptable to modern markets.

            As is to be expected, noting its religious nature and commercial potential, a lot of people are continually engaged in the the relentless efforts at blowing breaths of life into the decaying cadaver called acupuncture, and for that matter most other modernisations of archaic (traditional if you like) oriental healing methods. But most of us, who are not dependent on one or more varieties of “TCM” for our professional honour and livelihood, find it not interesting at all. On the contrary I, as many other, see it as misuse and even abuse of science, driven by a blend of blind faith and business interests.
            The exceedingly poor attempt at corroborating acupuncture discussed here is but one example of how low the standard is in this field
            Acupuncture has had much more than a fair chance at proving itself. Almost a century of widespread use and experiments with its modern reincarnation. Many of my colleagues believed in it several decades ago. Some even fervently. Very few still do. Most have given up on it as they realise after honestly trying, that it simply does not work. Saying that they must have been doing it wrong or otherwise belittling their honest efforts, is not going to change reality.
            The high hopes for finding ways to explain how the pins mediate their magic have, despite how hard you believe otherwise, run into the proverbial sand. Of course, purveyors of pin-pricks choose to interpret the evidence otherwise.
            To summarise, accumulated evidence shows that acupuncture was nothing but blood letting techniques until the beginning of the 20th century when it was re-invented into a theatrical parlour act using thin, more benign (but not totally safe) needles, which by the way were not produced before advances in metallurgy made it possible a few centuries ago.

            Continuing to beat a dead horse will not bring it to life.

            As to your notion that great things can come from healthy respect for traditional medicine and so forth, I see that Frank has replied quite adequately to that.

          • Be careful not to open your mind so much that your brains fall out..

          • Bjorn

            “I have actually tried reading parts of this strange text.” Good for you for at least trying. It must be pretty confusing, if you don’t know what some of the basic terms mean. Without that basic understanding, one could come to some pretty strange conclusions.

            But, the section on bloodletting and the section on needles are pretty straightforward. I’m surprised you had trouble with those.

          • The tiresome character behind “jm” is repeatedly claiming scholarly knowledge of the inner secrets of mysterious oriental magic. Even that (s)he can explain how and what is “qi” and other unreal archaic inventions. But when asked to elaborate on the matter or provide evidence and examples of this deep knowledge, it only results in more inuendos, ad hominems and unsubstantiated claims.

          • Bjorn

            You seem to want to make things more mysterious and fantastical than they are. The “scholarly knowledge” of reading the section on bloodletting and the section on needles? I think they’re pretty readable, and not very long. You actually spend more effort constructing fantasy around the whole thing than it would take to just read it.

            And by “inner secrets”, you must be referring to the fact that they didn’t print those sections on the cover.

      • Congratulations, Tom. I wondered who’d be the first on this blog to bring up Youyou Tu’s Nobel prize as if it’s proof of the validity of TCM. What she did is no different fundamentally from what many scientists have done over decades: looking at everything from old wives’ tales to traditional folk medical remedies and sorting out which natural products (plants and microbes) produce molecules that have the properties of medicines. From these efforts we have a wide plethora of drugs in daily use. The wheat of folk remedies has been sorted from the chaff to a colossal extent.
         
        But it would be a serious error of judgement to imagine that, because a few traditional medicines in any culture prove to have a genuine clinical effect, that shows that every aspect of traditional medicine (Chinese, African, European, South American or whatever) must be true.

        • Frank, you make wild assumptions here. Firstly, in no way am I suggesting the Nobel prize is ‘proof of the validity of TCM’ – I said she was directly inspired by Chinese medicine, which is patently true. I’m using it as an example of what can result when someone has an open mind and a deep understanding of Chinese medicine, as well as Western medicine. Yes, there is a plethora of drugs synthesized from traditional remedies, which is one reason to keep investigating them with healthy respect. In my opinion, it’s exactly the same deal with acupuncture.

          Also, in no way do I suggest that ‘every aspect of traditional medicne…must be true’. You are twisting my words to fit your own assumptions about me as an advocate of something you have fixed your opinion about – just the sort of unhelpful approach that litters this site.

          • please have a look at the following post which is all about this Nobel Prize

          • There is no Western vs Eastern medicine–just medicine. The rest predates modern medicine and the scientific era. It may contain nuggets worth exploring, but you all need to learn to know when to discard discredited ideas and move on to more promising ideas like the Nobel winner

  • It’s very important to distinguish between “regular” acupuncture (needles, points, qi, blah, blah, blah) and the sleight of hand used here of adding the “electro” to the method. They are not the same thing. I’m not endorsing either, but the results of this study might (big qualifier) have more to do with the electro than the acupuncture.

    Dr. Mark Crislip of ScienceBasedMedicine covered the many faces of The Acupunctures in this post:

    https://www.sciencebasedmedicine.org/acupuncture-vignettes/

  • After 40 years on a CRT, I developed hypertension from not moving my head well. I found a chiropractor here in Florida who wrote a book about manipulating the Atlas joint, after six months manipulation by this chiropractor my BP went down to 130/70 from 220/110. Just saying…..

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