3.1.1 Trial Location and Participants
3.1.2 Trial Definition of Hypertension
3.1.3 Trial Acupuncture Protocols
3.2 Findings – Effects of Acupuncture on Hypertension
3.2.1 Acupuncture IS Effective at Reducing Hypertension
3.2.2 Acupuncture MAY BE Effective at Reducing Hypertension
3.2.3 Acupuncture IS NOT Effective at Reducing Hypertension
3.2.4 Sustainability of the Effects of Acupuncture on Hypertension
3.2.5 Negative Effects of Acupuncture for the Management of Hypertension
3.3 Critical Review
3.3.1 Use of Acupuncture in the Trials
3.3.2 Confounding in the Trials
3.3.3 Problems with the Trial Methodology
4.0 Discussion
4.1 Findings in the Context of the Broader Literature
4.2 Future Research on Acupuncture for Hypertension
4.3 Findings in the Context of Other Randomised Controlled Trials
4.4 The Nurse’s Role in Acupuncture for Hypertension
4.5 Limitations of the Review
5.0 Conclusion and Recommendations
References
Appendix 1: PICO
Appendix 2: Keywords
Appendix 3: Inclusion and Exclusion Criteria
Appendix 4: Results from Database Searches
Appendix 5: PRISMA Diagram of Search Results
Appendix 6: Overview of Selected Studies
Appendix 7: Data Extraction
Appendix 8: CASP Critical Appraisal
1.0 Introduction, Background and Rationale
This paper presents a systematic review about the effects of acupuncture on hypertension. Chapter 1 begins by providing an overview of hypertension and acupuncture, and the rationale for and aims of the review. Chapter 2 then outlines the review methodology, and justifies this with reference to the literature. Chapter 3 presets the findings of the review, and a critical discussion of the literature on which these findings are based. Chapter 4 discusses the findings in relation to the broader literature, and also considers their application to practice. Chapter 5 concludes with a summary of the review and recommendations for practice and research.
1.1 Hypertension
‘Hypertension’ is the clinical term for high blood pressure (Bradley, 2015). In the United Kingdom (UK), hypertension is diagnosed when a person’s persistent systolic blood pressure is ≥140mmHg and/or their persistent diastolic blood pressure is ≥90mmHg (National Institute for Health and Care Excellence [NICE], 2011). Hypertension is also diagnosed when a person must take anti-hypertensive medication/s to maintain a ‘normal’ blood pressure (Bradley, 2015).
The pathophysiology of hypertension is complex. In a small number of cases there is a clear physiological cause, but in perhaps up to 95.0% of cases the cause is undetermined and idiopathic (Chen, 2012). Hypertension is known to result when the body’s processes for blood pressure regulation – including the renin-angiotensin-aldosterone system (RAAS) – become chronically disordered (Chen, 2012). However, the reason/s why these processes become disordered, and why they remain so instead of returning to homeostasis, is frequently unclear (Chen, 2012). Increasingly, it is understood that hypertension has epigenetic and environmental causes (e.g. dietary intake, physical activity, obesity, etc.) (Chen, 2012; Bradley, 2015). Hypertension is also recognised to be strongly correlated with increasing age (Bradley, 2015).
Hypertension is problematic because it significantly increases a person’s risk of developing cardiovascular disease. This risk occurs because hypertension places the heart and vasculature under chronic excessive strain (Bradley, 2015). For a person with moderate hypertension, the risk of cardiovascular-related mortality is at least 1.31 times greater than for a person without hypertension (Wu et al., 2015). For each 10mmHg by which a hypertensive person’s blood pressure is reduced, their overall risk of experiencing a harmful cardiovascular event (e.g. a myocardial infarct, a stroke, heart failure, etc.) decreases by 20.0% (Ettehad et al., 2016).
For this reason, treating hypertension is a priority identified in UK clinical guidelines (NICE, 2011). These guidelines recommend
