Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.

Useful pages: Stroke ; Angina, Arrhythmias, Coronary Heart Disease, and Heart Failure

Research and Resources on Blood Pressure, Hypertension and Acupuncture:

A scholarly search of the available research studies on “acupuncture” + “blood pressure” reveals over 43,400 papers from journals, and narrowing this to “RCT” leads to over 4,500 hits, of which 37% have been carried out since 2017.  A scholarly search of the available research studies on “acupuncture and hypertension” reveals over 44,500 papers from journals, and narrowing this to “RCT” leads to over 4,500 hits, of which 40% have been carried out since 2017.  This indicates the extent to which acupuncture is used traditionally and currently in this area; with scientific research increasing in pace and demonstrating an area worthy of scientific appraisal and consideration.  

Interpreting the research:

When reading health research, it is important to know that Systematic Reviews or Meta Analyses of a large number of high-quality research studies are the very best way to be able to say to what extent a given treatment can address a condition, symptom, or set of symptoms.  The next best level of evidence is the individual Randomised Controlled Study (RCT) which uses a systematic technique to compare two or more groups of patients receiving different treatments (or a treatment against a “control”, or no treatment).  In acupuncture trials, the nature of the control group is of particular interest as it is hard to blind a patient to whether they are having a needle inserted or not, and even more challenging to blind the researcher/team to this.

The means and quality of how research is carried out varies considerably from country to country, and in terms of how an intervention is compared to another intervention (or a control).  Of note is the fact that “sham” acupuncture (where needles are placed in apparently inert locations rather than traditional acupuncture points) is not really an inert process as it has physiological effects, so that comparing sham and “true acupuncture” may therefore not give a clear picture alone; but and form a part of a research body where acupuncture versus no treatment, vs conventional treatment or vs a different approach/modality also form part of the evidence base.

The n= figure (where quoted in research) tells you how many people were participants in the study, and usually the larger a study (when it is of good quality and design), the more likely it is to be reliable and applicable to larger populations. When (statistical) “significance” is discussed in view of studies it has a very particular meaning – it is the confidence in the data (using statistical tests) that tells us how likely a result could have just come about by chance. The lower the possibility of a chance result, the more likely it is due to the intervention in the experiment. When you are reading a trial/study, the “p” is the number telling us of significance, and this must be under 5% (or p less than 0.05) to mean we can say it is a (statistically) “significant” result.

The Research:

Hypertension is a common cardiovascular disease that affects about one billion people worldwide. 

A meta-analysis of studies compared approaches to treating essential hypertension (31 trials; n=2649; Tan et al, 2019), concluded that acupuncture may be useful in addressing hypertension, albeit that quality of the studies was limited and further research was warranted.  Another analysis of 10 trials in BP amongst stroke patients  (Hong et al, 2020; n=847) concluded that acupuncture may be a suitable treatment option for regulating BP after stroke but also noted the low-quality in the data and as need for further well-designed trials.

Niu et al, (2019) examined 13 systematic reviews of 14 non-drug therapies (including acupuncture) in addressing high blood pressure.  They concluded that massage and acupuncture plus an antihypertensive drug may benefit people who wanted to lower their blood pressure; once again methodological issues around available research limited the strength of the recommendations.

Li et al, 2014 carried out a systematic review and meta-analysis of 4 RCTs (n=386) that compared acupuncture with sham acupuncture for treating essential hypertension, in order to assess the effectiveness and safely of acupuncture as an adjunctive approach for the condition, using statistical methods to pool the results and compare the average blood pressure changes between the groups.  Acupuncture was found to significantly lower systolic blood pressure (SBP) and diastolic blood pressure (DBP) in patients taking antihypertensive medications, but not in patients who were not taking medications.  Acupuncture was generally safe and well-tolerated, with only minor adverse events reported.  The authors concluded that acupuncture could be a promising adjunctive therapy for hypertension, but more large-scale and long-term trials are needed to confirm its efficacy and safety.

Acupuncture was found to be a promising adjunctive therapy for essential hypertension in Yin et al’s (2007) a double-blind, randomized, controlled trial, where acupuncture was assessed for its benefits as an add-on to conventional antihypertensive managements such as medication or lifestyle modification on patients with high blood pressure.  In the small (n=30) study, the real acupuncture group showed a significant decrease in mean BP after 8 weeks.  Auricular (ear) acupuncture has also been shown to reduce preoperative blood pressure (BP) elevation in different age groups in a prospective RCT (Ma et al, 2023; n=120).

Mechanism of action:

Animal model studies have shown physiological effects from auricular (ear) acupuncture on the Heart point, whereby using this point regulates cardiovascular function (heart rate, blood pressure). Cardiac related nerve cells were shown to be regulated by the use of Heart (auricular point), lowering blood pressure in the arteries, by means of activating a certain type of nerve cell receptor (baroreceptor sensitive neurons) in part of the brainstem (nucleus tractus solitarius) (Gao et al, 2011).

Acupuncture has been shown in many mechanism-of-action trials to be sympathoinhibitory (able to downregulate the sympathetic nervous system) and lower the stress response in brain and nervous system (Middlekauff et al, 2002).

Li et al (2014) proposed a possible mechanism of action for the lowering of blood pressure, in that acupuncture could regulate the renin-angiotensin-aldosterone system (RAAS), which is involved in blood pressure regulation, by stimulating specific acupoints that correspond to the kidney and liver meridians. The other mechanism is based on the Western medicine theory of modulating the autonomic nervous system (ANS), which controls the heart rate and vascular tone. They further hypothesized that acupuncture might activate the parasympathetic branch of the ANS, thus lowering the sympathetic activity and reducing the release of stress hormones that constrict the blood vessels.

See also angina, arrythmia and heart disease and heart failure, and stress pages

Regarding Your Individual Condition and Symptoms:

Whilst the scientific studies are of great interest to researchers and acupuncturists in terms of comparing protocols, for the patient not versed in research they are less accessible, which is why when we asked “can acupuncture work for my (condition or symptom) we are not able to give a simple yes or no response.  We are able to tell you what experience we have had in our decades of experience in practise, of the types of outcomes we have seen in similar cases, and give you an idea of our level of experience and knowledge in that area, and how this could relate to your own individual situation.  For this, we recommend booking a free telephone consultation where we can answer any questions you have and give a realistic appraisal of what acupuncture may be able to provide.

Resources:

British Acupuncture Council (BAcC) Hypertension factsheet on the research into acupuncture in this condition

BAcC Stroke Factsheet

BAcC Stress Factsheet

BAcC Angina, Coronary Heart Disease, Atrial Fibrillation and Heart Failure Factsheet

BAcC Anxiety Factsheet

References:

Gao XY et al. Acupuncture-like stimulation at auricular point Heart evokes cardiovascular inhibition via activating the cardiac-related neurons in the nucleus tractus solitarius. Brain Res. 2011;1397:19-27.

Li, D.Z., Zhou, Y., Yang, Y.N., Ma, Y.T., Li, X.M., Yu, J., Zhao, Y., Zhai, H. and Lao, L., 2014. Acupuncture for essential hypertension: a meta-analysis of randomized sham-controlled clinical trials. Evidence-Based Complementary and Alternative Medicine, 2014.

Ma, J., Zhang, Y., Ge, Q. and Wu, K., 2023. The effect of auricular acupuncture on preoperative blood pressure across age groups: a prospective randomized controlled trial. Clinical and Experimental Hypertension, 45(1), p.2169452.

Middlekauff, H.R., Hui, K., Yu, J.L., Hamilton, M.A., Fonarow, G.C., Moriguchi, J., MacLellan, W.R. and Hage, A., 2002. Acupuncture inhibits sympathetic activation during mental stress in advanced heart failure patients. Journal of cardiac failure, 8(6), pp.399-406.

Tan, X., Pan, Y., Su, W., Gong, S., Zhu, H., Chen, H. and Lu, S., 2019. Acupuncture therapy for essential hypertension: a network meta-analysis. Annals of translational medicine, 7(12).

Hong, S., Ahn, L., Kwon, J. and Choi, D.J., 2020. Acupuncture for Regulating Blood Pressure of Stroke Patients: A Systematic Review and Meta-Analysis. The Journal of Alternative and Complementary Medicine, 26(12), pp.1105-1116.

Niu, J.F., Zhao, X.F., Hu, H.T., Wang, J.J., Liu, Y.L. and Lu, D.H., 2019. Should acupuncture, biofeedback, massage, Qi gong, relaxation therapy, device-guided breathing, yoga and tai chi be used to reduce blood pressure?: recommendations based on high-quality systematic reviews. Complementary therapies in medicine, 42, pp.322-331.

Yin, C., Seo, B., Park, H.J., Cho, M., Jung, W., Choue, R., Kim, C., Park, H.K., Lee, H. and Koh, H., 2007. Acupuncture, a promising adjunctive therapy for essential hypertension: a double-blind, randomized, controlled trial. Neurological research, 29(sup1), pp.98-103.