Acupuncture treatment for hypertension: a case study
A 56-year-old man (height 165 cm, weight 75 kg) was admitted to The First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine on 24 September 2012 with hypertension and side effects of antihypertensive drugs. He was diagnosed with hypertension in 2007 and his usual BP was 160/100 mm Hg. He started taking levamlodipine 5 mg once daily in March 2011. However, his BP remained the same and he reported side effects such as flushing and palpitations. He was switched to irbesartan 150 mg once daily in July 2012. His BP remained at 140/85 mm Hg but he reported side effects of diarrhoea, fatigue and decreased sexual function, among others.\nHe denied a family history of alcoholism and cardiovascular disease and did not have a preference for a salty diet. He exercised about 2 h a day.\nInvestigations revealed mild hypocalcaemia (2.11 mmol/L) and reduced high density cholesterol (0.88 mmol/L). Transcranial cerebral Doppler showed increased blood flow in the right intracranial internal carotid artery while the blood flow frequency spectrum in the other cerebral vessels was normal. Carotid artery ultrasound revealed a plaque with a thickness of 2.0 mm in the left common carotid artery wall, which accounted for 25.6% of the blood vessel. Cardiac colour ultrasound revealed no findings in left ventricular hypertrophy: interventricular septum thickness at end-diastole (IVSTd)=10.9 mm, left ventricular posterior wall depth (LVPWd)=9.7 mm, E/A=0.87, left ventricular mass index (LVMI)=112 g/m2, relative wall thickness (RWT)=0.39.\nIn view of the side effects of his medication, the patient asked for a course of acupuncture. He received a total of 60 sessions of acupuncture treatment over the course of 12 weeks (5–6 treatments per week) from 24 September to 24 December 2012. Each acupuncture treatment session lasted 30 min. The acupuncture was stopped because he no longer had side effects from the antihytertensive drugs and he decided to return to work.\nDuring the treatments, acupuncture points LI4, LI11, ST36 and ST9 were used bilaterally for antihypertensive purposes. Needles were inserted 0.8–1.0 cun perpendicularly. Twirling with tonifying or reducing manipulation was applied (tonifying or reducing manipulation is to inspire jing qi through proper acupuncture technique). LI11, ST36 and ST9 were needled with tonifying manipulation for 1 min at a frequency of 120–160 twirls/min; LI4 was needled with reducing manipulation for 1 min at a frequency of 40–60 twirls/min. CV4, CV6 and SP6 were also needled to treat adverse drug reactions (eg, diarrhoea, fatigue).\nThe acupuncturists who administered the treatment had at least 10 years of experience. Stainless steel needles (Suzhou, China), 0.25×40 mm, were employed at corresponding points. Appropriate stimulation was applied in order to attain the de qi sensation, which was associated with physiological changes that played an important role in the effects of acupuncture.\nThe patient received individualised acupuncture treatments for hypertension and for adverse drug reactions such as diarrhoea and fatigue. Frequently used antihypertensive acupuncture points as described in systematic reviews are LR3, LI11, GB20, ST36 and ST40.\nIn this case, the antihypertensive point selection was based on Traditional Chinese Medicine meridian theory. In traditional concepts, points located on the Yangming meridian, such as LI4, LI11 and ST36, can ‘reconcile qi and blood’. We also selected ST9 Renying, a meeting point of the Stomach and Gallbladder channels that regulates qi and blood. Located next to the carotid sinus, ST9 is the pressure sensor of the human body that regulates BP. Based on TCM theory, CV4, CV6 and SP6 were chosen to treat diarrhoea and fatigue.\nOffice BP (OBP) was taken at each visit using an automated sphygmomanometer while seated and repeated after a 5 min break. If the systolic BP (SBP) or diastolic BP (DBP) changed more than 5 mm Hg within the 5 min period, a third measurement was taken. The average value was recorded.\nIn addition to OBP taken with an automatic sphygmomanometer, 24 h ambulatory BP monitoring (ABPM) was also applied to measure the daytime and night time BP. As an adjunct to OBP, ambulatory measurements of BP can assist in identifying ‘white coat hypertension’ and predicting the risk of organ damage and cardiovascular disease.