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 among the trials in terms of the type of acupuncture used (Chines versus Korean) and, as a result, in the acupoints accessed, the duration of the intervention, the number of acupuncture sessions (overall and per week), and the duration of each session. There were also problems associated with confounding in the studies – including in relation to the use of anti-hypertensive medications, the inclusion of patients with essential and secondary hypertension, the failure to control for the modifiable ‘lifestyle’ factors which impact hypertension, and the use of small cohorts. Further, there were complexities associated with the use of the randomised controlled trial methodology, which may not be suitable for studies on acupuncture, and controls treated with sham acupuncture, which may not be an inert treatment.
Subsequently, the trials selected for inclusion in this review do not provide high-quality evidence to inform clinical practice in relation to the use of acupuncture for the management of hypertension. The findings of this review must be applied in consideration of this limitation.
Based on the review’s findings, two evidence-based recommendations have been developed:
For nursing practice: Nurses may recommend, provide education on and (where they are trained and qualified to do so) administer acupuncture to patients with hypertension who choose to use acupuncture. Nurses should ensure patients understand that although acupuncture may not necessarily have an effect on their hypertension, it is unlikely to cause them harm.
For future research: Additional research on acupuncture for hypertension is essential to further informing evidence-based practice in relation to this topic. In particular, research must be conducted to determine the effects of acupuncture in combination with anti-hypertensive medication, the effects of continuous/ongoing versus block acupuncture sessions, and the effects of other types of acupuncture (e.g. laser acupuncture, electro-acupuncture, warm needling, etc.) on hypertension. This research should consider the methodological limitations noted above. Randomised controlled trials and other research methodologies should be used.
References
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Bolivar, JJ (2013), Essential hypertension: An approach to its etiology and neurogenic pathophysiology, International Journal of Hypertension (online), retrieved 18 July 2019, from Bradley, EG (2015), Nursing Management: Hypertension, in Brown, D, Edwards, H, Seaton, L & Buckley, T (Eds.), Lewis’ Medical-Surgical Nursing: Assessment and Management of Clinical Problems (4th Edn.), Sydney: Mosby-Elsevier, pp.716-734. Bronsert, MR, Henderson, WG, Valuck, R, Hosokawa, P & Hammermeister, K (2013), Comparative effectiveness of antihypertensive therapeutic classes and treatment strategies n initiation of therapy in primary care patients; A distributed ambulatory research in therapeutic network (DARTNet) study, Journal of the American Board of Family Medicine, vol. 26, no. 5, pp. 529-538. Burns, N & Grove, SK (2011), Understanding Nursing Research: Building an Evidence-Based Practice(5th
