Hypertension study give us much to ponder

A report of a recent study regarding acupuncture treatment for hypertension caught my eye for several reasons. The good news was that acupuncture showed itself to be effective not only to temporarily lower blood pressure has had been seen in previous studies but this study also found acupuncture was effective in lowering both systolic and diastolic pressure on a long-term basis. I have not seen a copy of the actual study and am not sure just how long they followed these test subjects but I think we can learn a lot by carefully considering this and previous studies and applying some critical thinking to the subject of using Chinese Medicine in the real world.

Whenever I see a report of any acupuncture study, I want to know first-off how many treatments were done over what period of time. I have written of this before: the number and frequency of acupuncture treatments are to acupuncture what dosages are to herbs or drug therapies. Unlike herbs or drug therapy dosages, however, not nearly enough attention is paid to the question of how many treatments will it take over what period of time to get what is possible and practical out of acupuncture. In this hypertension study, five treatments a week were done over three months of time. That would mean about 65 treatments over three months. Many studies done with acupuncture are doing far fewer treatments over less time and the results often end-up showing only modest results. I have long felt many acupuncture studies were showing subpar results from under-treatment; like giving only half the effective dosage of a medication.

As a general rule, the studies showing higher number and frequency of treatment tend to come out of China – a country that has had fully and now mostly socialized medicine with little if any payment for acupuncture. The studies with fewer treatments and greater spacing between treatments are mostly from Western countries where payment for acupuncture treatment is either on a cash basis or from tight-fisted insurance health plans. In other words, the question of spacing and frequency (dosage) of acupuncture treatments during scientific research is mostly guided by what practitioners tend to do in the country the research is being conducted in rather than first pondering what would constitute an effective dosage without regard to costs.

Many researchers in the West do not know enough about the dynamic between frequency and number of acupuncture treatments to understand what an effective dosage would be so they tend to look to practitioners in their country to see how they manage treatment numbers and frequency.  Unfortunately, because many acupuncturists in the West are trying to survive in a system where there is little if any third-party payment for acupuncture and thus end-up under-treating their patients, researchers see this as how clinicians use acupuncture and design their studies also under-treating test subjects. This being the case, many studies show acupuncture under-performing just as many acupuncture patients in the West get subpar results due to their acupuncturists trying to make the treatment work with too few treatments.

Those of you who follow my work know that I put a great deal of emphasis on the question of how to make our services work in the real world and trying to find the effective dosage of acupuncture while making it affordable is a major issue that needs to be addressed. We also need to consider that most of us have additional training in Chinese herbs and things like diet and exercise therapies. So while I applaud this study for having the insight to recognize that treating essential hypertension would take frequent acupuncture treatments over an extended period of time, I actually think this does not give us a good model for practice. Why? For starters we have herbs that work well in many hypertension cases that are safe and can be given for a fraction of the cost of acupuncture.  And just adding herbs does not yet address diet and exercise guidelines that patients should follow to improve the lifestyle factors that are largely responsible for causing hypertension in the first place. 

I have been telling my patients for years that acupuncture alone is not a practical treatment for long-term management of essential hypertension even though I was sure acupuncture alone could work if one could gave enough treatments over a long enough period of time. This study proves that is the case. In my book I gave the rough estimate that problems a patient has had for years (or took years to develop) take months to treat, those suffered for months take weeks to treat, those suffered for weeks take days to treat, and those only days old might respond to a few treatments. I will bet you though that even three months of five times a week acupuncture would not keep most of those test subjects’ hypertension under control for the next 2,5, or10 years.  So how do I suggest managing patients with essential hypertension? Let me know what you think of the issues I raised above and if there is enough interest, I will offer my advice.      

Here is the link to the report of the hypertension study: http://www.healthcmi.com/index.php/acupuncturist-news-online/664-acupuncturedepresseshypertensionli11li4

Matthew Bauer

I have found magnesium supplements fish oil as well as a big glass of blended celery a day really brings down the blood pressure. As long as heavy walking three times a week is also included for a hour or so. Remarkable results with this protocol. Combining with ear seeds to maintain the relaxation and some discussion about repressed emotions and how to express like writing and burning letters ect. Weekly visits just to relax and relieve stress recommended usually some added massage and teach some meditation to do daily. More of a supporting and less acupuncture just to keep on track and make the session more of a holiday than a treatment.

R.Ac.

I think you offer very good advice here. I also believe walking is the most important exercise people can do including hypertension patients. You hit all the main points, some regular acutherapy to reduce stress, foods and simple, safe supplements, and exercise. There are also Chinese herbs that help a lot. I also require any hypertension patient taking medication to monitor their BP regularly, keep a log of BP readings and then bring those reading to me for their records. I will NEVER treat a hypertension patient who is on meds and wants to reduce or get off of them if they won’t agree to keep a log of their BPs. You want that record to show that your management of the hypertension was safe and conservative.

Matthew Bauer