Lee Hyangsook, Kim Song-Yi, Park Jongbae, Kim Yun-Ju, Lee Hyejung, Park Hi-Joon
Acupuncture and Meridian Science Research Center (AMSRC), Kyung Hee University, Seoul, South Korea.
Am J Hypertens. 2009 Jan;22(1):122-8. doi: 10.1038/ajh.2008.311. Epub 2008 Nov 13.
We conducted a systematic review to estimate the effect of acupuncture on blood pressure (BP) in hypertensive patients.
Electronic literature searches for randomized controlled trials (RCTs) of acupuncture were performed in six electronic databases to June 2007 without language restrictions.
Eleven RCTs testing acupuncture either as an adjunct or an alternative met our inclusion criteria and they showed a wide variety of methodological quality, mainly due to poor reporting. Three sham-controlled trials out of 11 studies were statistically pooled: systolic BP (SBP) change was not statistically significant (mean difference -5 mm Hg, 95% CI (-12, 1), P = 0.12) and acupuncture only marginally reduced diastolic BP (DBP) by 3 mm Hg (95% CI (-6, 0), P = 0.05), but substantial heterogeneity was observed (I(2) = 92% for SBP, I(2) = 79% for DBP). When given with antihypertensive medication, acupuncture significantly reduced SBP (-8 mm Hg, 95% CI (-10, -5), P < 0.00001) and DBP (-4 mm Hg, 95% CI (-6, -2), P < 0.0001) and no heterogeneity between studies was detected. Four studies that investigated acupuncture against antihypertensive medication indicated noninferiority of acupuncture in lowering BP, albeit the quality of them was poor, and their sample sizes were not satisfactory as an equivalence study. Other studies comparing acupuncture with various control procedures had inconsistent findings and most of them were of low methodological quality.
Considering the limitation of the four positive noninferiority studies and the results of the meta-analysis of the three sham-controlled studies, the notion that acupuncture may lower high BP is inconclusive. More rigorous trials are warranted.
我们进行了一项系统评价，以评估针刺对高血压患者血压（BP）的影响。
截至2007年6月，在六个电子数据库中进行了关于针刺的随机对照试验（RCT）的电子文献检索，无语言限制。
11项将针刺作为辅助或替代疗法的RCT符合我们的纳入标准，它们显示出广泛的方法学质量差异，主要是由于报告不佳。11项研究中的3项假针刺对照试验进行了统计学合并：收缩压（SBP）变化无统计学意义（平均差异-5 mmHg，95%可信区间（-12，1），P = 0.12），针刺仅使舒张压（DBP）略有降低3 mmHg（95%可信区间（-6，0），P = 0.05），但观察到显著的异质性（SBP的I² = 92%，DBP的I² = 79%）。当与抗高血压药物联合使用时，针刺显著降低SBP（-8 mmHg，95%可信区间（-10，-5），P < 0.00001）和DBP（-4 mmHg，95%可信区间（-6，-2），P < 0.0001），且各研究间未检测到异质性。四项比较针刺与抗高血压药物的研究表明，针刺在降低血压方面不劣于药物，尽管其质量较差，且作为等效性研究其样本量并不理想。其他比较针刺与各种对照程序的研究结果不一致，且大多数研究方法学质量较低。
考虑到四项阳性非劣效性研究的局限性以及三项假针刺对照研究的荟萃分析结果，针刺可能降低高血压的观点尚无定论。需要进行更严格的试验。
