Treating Hypertension (High Blood Pressure) in the Acupuncture Clinic

This is the abstract from a study on hypertensive patients from Professor John Longhurst's lab. It is a sort of summary of his findings discussed here and here.
A few comments... He uses electroacupuncture because he says it's easier to make it standard across patients. This was something I noticed repeatedly at the conference: most researchers are using electroacupuncture. I had a few different discussions with Dr. Longhurst, and he thinks that if you don't do electroacupuncture, you're really not stimulating because the stimulus goes away during the session. I don't agree with that. I think that the needles provoke a "micro-injury" just by being there and work just fine, even if you don't repeatedly stimulate them. Manual acupuncture, without electro, is my standard operating procedure. I use electro acupuncture if I'm following a specific protocol, for example for infertility or PCOS, or in musculoskeletal cases where the patient has reached a "plateau." I hardly ever start with electrical stimulation because of the tendency for it to aggravate the condition and the patient. I would never have the heart to do electrical stimulation at P6, as they do in this study. It's such a sensitive spot, I will try their other choice of LI11 and LI10 which is equally effective according to their work.
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Acupuncture Treatment of Hypertension
John C. Longhurst, MD, PhD and Peng Li, MD, Department of Medicine, University of California, Irvine
Heart disease in both men and women has become the major cause of death and disability in both developed and developing countries. Coronary atherosclerosis, the leading cause of heart disease, has a number of risk factors that increase its incidence. These include hypertension, hypercholesterolemia, diabetes mellitus, family history, obesity, physical inactivity and chronic stress. Hypertension, in particular, is reversible if patients are treated early and blood pressure is lowered to normal levels. Although a number of drug therapies have been shown to be valuable in lowering this risk factor, many patients do not take medications faithfully because of their common side effects and need for daily dosing. As such, there is a strong rationale developing alternative regimens to control blood pressure. One such therapy is acupuncture. Acupuncture is a form of integrative medicine that has substantial evidence demonstrating its mechanisms of action to lower sympathetic outflow, one of the major causes of elevated blood pressure. For example, studies in our laboratory show that, through an opioid mechanism in the brain stem, acupuncture can lower reflex elevations in blood pressure. Furthermore, we have shown that low frequency, low intensity electroacupuncture at some acupoints, such as P5-P6 and S36-S37, is most effective in lowering elevated blood pressure for prolonged periods of time. In the last decade several studies have been conducted showing that acupuncture is capable of lowering blood pressure to a small extent for the period of time during which it is applied. Although these studies indicate a possible role for acupuncture in treating hypertension, they have been confounded by use of a variety of different acupoints, some of which may not have strong cardiovascular actions, use of manual acupuncture, which unlike electroacupuncture cannot be standardized between patients, the use of very frequent acupuncture, which because of patient incompliance could limit success for long-term treatment, and the absence of regular follow-up, which does not provide an understanding of the duration of acupuncture’s action. To overcome these obstacles, we have embarked on a program of treatment of patients with mild to moderate hypertension using 30 min of low intensity (2 mA), low frequency (2 Hz) electroacupuncture at P5-P6 and S36-S37, a modality and site of action that we have shown has the greatest action on sympathetic outflow and elevated blood pressure in our experimental studies. Furthermore, all patients were off antihypertensive medications for the duration of the study and agreed to acupuncture treatment once weekly for an eight week period with a further follow-up for an additional eight weeks to determine acupuncture’s duration of action. Ambulatory automated blood pressure monitoring demonstrated that both average and 24 hour peak systolic and mean arterial blood pressures were lowered by electroacupuncture after 4-6 weeks of therapy by as much as 11-18 mmHg and that the duration of action of lasted for up to 4 weeks after termination of acupuncture in 73% of individuals treated. Conversely, 69% of a group of control hypertensive subjects treated at LI6-LI7 and GB37-GB39 (cardiovascular inactive acupoints demonstrated in our experimental studies), , did not demonstrate any change in blood pressure. These studies, guided by our results in experimental studies, suggest that low intensity and low frequency electroacupuncture applied once weekly at 2 acupoints demonstrated to have a strong influence on sympathetic activity after 4-6 weeks demonstrate a profound and prolonged antihypertensive response in many patients with mild or moderate hypertension. Additional work is needed to determine the optimal frequencies of repetitive stimulation during the initial period of intervention as well as during follow-up therapy for reinforcement of the blood pressure lowering action of acupuncture. Supported by grants from the NIH, HL063313 and HL072125-10, the Dana and Adolph Coors Foundations.

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Treating High Blood Pressure in the Acupuncture Clini

This is the latest data on the patient we've been following on this blog here and here. He is maintaining control of his blood pressure very nicely in spite of the fact that he hasn't been able to exercise as much as I recommend, nor has he taken the excess weight off. But he has followed through with his monthly acupuncture and takes his herbs religiously.
I did HRV monitoring on him when he came in on Wednesday and his LFR/HFR decreased from .68 to .57.
His SD1/Sd2 went down from .39 to .29 (not a positive result)
But his Sample Entropy went from 1.11 to 1.48 which, in my opinion is the most sensitive marker.
(Brief primer: LFR/HFR stands for Low Frequency/High Frequency HRV. If this decreases, it is interpreted to mean that the stress response in decreased. So decrease in LFR/HFR=decreased stress. The other measure SD1/Sd2, is a nonlinear method, if this ratio increases =decreased stress.)
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Typical Patient who comes to my Acupuncture Clinic

I thought I might start to feature some case studies of some of my patients. This patient is particularly interesting. She is in her mid sixties and came in for help with Neuropathy of her feet. Her other problems include high cholesterol and high blood pressure. It turns out that the neuropathy was made much worse by Lipitor. She finally convinced her physician to discontinue it, and she was doing better but then he put her on another statin. Her neuropathy got so intense that she couldn't walk without a cane and was crying out from the pain. She stopped it and came into the clinic to see me.
I gave her treatment for stress and for the neuropathy in her feet. I saw her for the first time on a Thursday, and by the following Monday the pain in her feet was much improved, and her blood pressure had remained below 140 systolic and below 80 diastolic. She can walk without a cane now.
Of course it is hard to tell if the acupuncture helped or if it was tincture of time being off of the statin. Similarly with the blood pressure, it might have come down with the lessening of the pain in her feet.
I will continue to treat her for both problems, at least for awhile, and try to get her blood pressure low enough that she can consider cutting back on medications.
Interestingly, she had Clostridia dificil last year. A nasty life threatening type of colitis that is usually caused by antibiotics. And sure enough, she had been treated for 6 months with antibiotics for a bladder infection. She was also diagnosed with COPD because of a dry cough, when dry cough is a typical side effect of Lisinopril, something I've seen quite a bit in my clinic. The cough went away once she discontinued the Lisinopril, COPD, um, gone.
These are the types of medical histories that make people open to alternative medicine. First, do no harm.
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Acupuncture for High Blood Pressure

Here is the update for one of my patients being treated with acupuncture and herbal therapy for hypertension. He comes in once a month for treatment and takes Great Yin and Gastrodia Relieve Wind from Health concerns. His blood pressure has remained under control without medications. In addition, his constipation is gone (often a side effect of effective acupuncture treatment.)

Neuro pathways involved in acupuncture decreasing Blood Pressure

This is a nice study that looks at the pathways involved in acupuncture's effect on blood pressure. I have had good results in my clinic in patients with hypertension as long as they are willing to follow through with their visits! Once their blood pressure has come down, monthly visits suffice usually with herbal supplementation.

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Neural mechanism of electroacupuncture's hypotensive effects
Auton Neurosci. 2010 Oct 28;157(1-2):24-30. Epub 2010 May 5.
Neural mechanism of electroacupuncture's hypotensive effects. Li P, Longhurst JC
Department of Medicine, Susan-Samueli Center for Integrative Medicine, University of California, Irvine, California 92697, USA. pengli@uci.eduAbstract

EA at P 5-6 and S 36-37 using low current and low frequency may be able to reduce elevated blood pressure in a subset of patients (∼70%) with mild to moderate hypertension. The effect is slow in onset but is long-lasting. Experimental studies have shown that EA inhibition of cardiovascular sympathetic neurons that have been activated through visceral reflex stimulation is through activation of neurons in the arcuate nucleus of the hypothalamus, vlPAG in the midbrain and NRP in the medulla, which, in turn, inhibit the activity of premotor sympathetic neurons in the rVLM. The arcuate also provides direct projections to the rVLM that contain endorphins. Glutamate, acetylcholine, opioids, GABA, nociceptin, serotonin and endocannabinoids all appear to participate in the EA hypotensive response although their importance varies between nuclei. Thus, a number of mechanisms underlying the long-lasting effect of EA on cardiovascular function have been identified but clearly further investigation is warranted.

Good results with Acupuncture for a patient with High Blood Pressure

On a more anecdotal basis, I saw a patient today who has been coming to me for about 6 months to treat high blood pressure. He had no desire to take medications, and so was seeking some other alternatives. He is 67 and works in a stressful job as a taxi cab dispatcher. He had spent some time in Asia earlier in his working life so was open to acupuncture as an alternative.
He came twice weekly for 6 weeks and then weekly for 2 months. I treated him with classic points for decreasing rising yang, and also points that have been shown to calm the autonomic nervous system in studies, like sishencong and 6MC. We added daily herbal supplements in addition to the acupuncture treatments. In his particular case a Yin tonic was key. He now comes in once a month and has maintained his blood pressure in a healthy range. Here is a chart of his BP ( bit blurry, sorry!) It may not look super dramatic, but it's the difference between taking medications and not.

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