Where it is appropriate to the clinical setting, it may also be possible for nurses to administer acupuncture to patients with hypertension. Zheng et al. (2018) caution that clinicians who administer acupuncture must be appropriately trained and qualified to do so. However, the development of modern, novel forms of acupuncture – like laser acupuncture – mean nurses may not necessarily require advanced TCM training to administer acupuncture (Litscher et al., 2012). Zheng et al. (2018) also emphasise the importance of developing simple protocols to enable acupuncture for hypertension to be administered in routine clinical practice. Nurses must always work within their scope, and the policies and procedures of the clinical setting where they practice. However, nurses’ role in administering acupuncture is a key future consideration.
4.5 Limitations of the Review
The limitations of the randomised controlled trials selected for inclusion in this review were critically analysed in a previous section. There were also limitations of the review methodology itself. The findings of the review must be understood in the context of these limitations.
Most significantly, the review was limited to studies published in or translated into English. As noted, this was necessary because there was no scope in this review for translation. However, Higgins and Green (2011) suggest that the use of an English-language limiter inevitably results in the exclusion of studies which are relevant to the research topic. This is a particular problem in relation to studies on acupuncture: as it is a TCM therapy, it is reasonable to assume that there are a large number of trials on acupuncture for hypertension in Chinese languages.
The review also has a number of other limitations. For example: only a small number of databases were searched, and it is possible that more relevant studies would have been identified if additional databases were searched. The review was limited to studies which used a randomised controlled trial methodology, despite the limitations of this methodology for research on acupuncture. Further, the review was limited to studies which tested needle acupuncture and used sham acupuncture as a control treatment, even though a variety of other randomised controlled trials on acupuncture for hypertension were identified. These are important considerations for future systematic reviews investigating acupuncture on hypertension.
5.0 Conclusion and Recommendations
This systematic review was undertaken to answer the research question, ‘In patients with hypertension, is acupuncture, in comparison to sham acupuncture, effective at reducing systolic and/or diastolic blood pressure?’ Comprehensive searches were undertaken on five of the largest electronic databases. From the 102 relevant studies identified in the searches, six randomised controlled trials were selected for critical analysis, quality appraisal and synthesis.
The trials selected for inclusion in this review were inconclusive about whether acupuncture, in comparison to sham acupuncture, is effective at reducing blood pressure in people with hypertension. Some of the trials selected suggested that acupuncture is more effective than sham acupuncture at reducing blood pressure, while others found it might be more effective, and another found it was not more effective. None of the studies identified significant harms associated with the use of acupuncture for hypertension. It seems reasonable to conclude that acupuncture may, but will not necessarily, have a positive effect on hypertension. It also seems reasonable to state that acupuncture is unlikely to cause harm to those who choose to use it.
It must be emphasised that there were a number of limitations with the studies selected for inclusion in this review, particularly when their findings were synthesised. Significantly, there were differences
