It must also be emphasised that only needle acupuncture was tested in the trials selected for inclusion in this review. However, there are a variety of other types of acupuncture which may be used in clinical settings – including, for example, laser acupuncture, electro-acupuncture and warm needling (Li et al., 2018). Some of these approaches, and particularly laser acupuncture, do not necessarily require a clinician to have advanced TCM training (Litscher et al., 2012); therefore, they may be simpler for nurses to apply in routine practice. Again, further research on the effects of other types of acupuncture on hypertension is important to inform practice.
4.2 Future Research on Acupuncture for Hypertension
As shown in the previous section, to enable evidence-based practice, there is a need for ongoing, quality research on the topic of acupuncture for hypertension. The problems with the use of randomised controlled trials for acupuncture research were critically analysed earlier. Because of these problems, other methodologies should be considered for future research.
For example: Cevik and Iseri (2013) conducted a high-quality longitudinal cohort study to investigate the effects of acupuncture on hypertension. As stated by Houser (2018: p.266), the longitudinal cohort study methodology provides a “powerful way” of assessing the effects of interventions over time. Longitudinal cohort studies are also ideal for investigating the effects of treatments on chronic conditions like hypertension (Schneider et al., 2013). This methodology is therefore an important consideration for future research on acupuncture for hypertension.
4.3 Findings in the Context of Other Randomised Controlled Trials
In addition to the Cochrane systematic review cited earlier (Yang et al., 2018), there are also a number of other systematic reviews and meta-analyses published in the previous decade which investigate the effects of acupuncture on hypertension. Each of these studies used different methodologies with different selection criteria to this review, and none included the same six randomised controlled trials selected for inclusion in this review. However, all of these studies agree with the findings of this review: that acupuncture may, but will not necessarily, have a positive effect on reducing the blood pressure of a person with hypertension (Lee et al., 2009; Wang et al., 2013; Li et al., 2014; Zhao et al., 2019). In the systematic reviews and meta-analyses where the safety of acupuncture for hypertension was also investigated, the studies also agreed that acupuncture was safe (Wang et al., 2013; Li et al., 2014; Zhao et al., 2019).
These systematic reviews and meta-analyses also came to the same conclusion as this review regarding the lack of heterogeneity in the primary studies about acupuncture for hypertension (Lee et al., 2009; Wang et al., 2013; Li et al., 2014; Zhao et al., 2019). In all studies, this caused difficulties with drawing robust conclusions and creating trustworthy evidence to inform practice. This again highlights the importance of ongoing, quality research on the topic, noted previously.
4.4 The Nurse’s Role in Acupuncture for Hypertension
It is important to consider the nurse’s role in acupuncture for hypertension. As shown previously, the nurse certainly has a role in supporting and educating patients who choose to undergo acupuncture for their hypertension. They may also have a role in recommending acupuncture for hypertension, in patients who may be interested in this as an adjunctive to anti-hypertensive medication. In both cases nurses must inform patients of the limitations of acu
