Abstract
Hypertension is a major public health problem affecting over one billion individuals worldwide. This disease is the result of complex interactions between genetic and life-style factors and the central nervous system. Sympathetic hyperactivity has been postulated to be present in most forms of hypertension. Pharmaceutical therapy for hypertension has not been perfected, often requires a multidrug regimen, and is associated with adverse side effects. Acupuncture, a form of somatic afferent nerve stimulation has been used to treat a host of cardiovascular diseases such as hypertension. It has long been established that the two major contributors to systemic hypertension are the intrarenal reninangiotensin system and chronic activation of the sympathetic nervous system. A number of important studies on the baroreflex response and its response to acupuncture are discussed. The inhibitory effects of acupuncture on the rostral ventrolateral medulla (rVLM) reduces sympathetic nerve activity and blood pressure suggesting overactivity of the angiotensin system in this nucleus may play a role in the maintenance of hypertension. Our experimental studies have shown that electroacupuncture stimulation activates neurons in the arcuate nucleus, ventro-lateral gray, and nucleus raphe to inhibit the neural activity in the rVLM in a model of visceral reflex stimulation-induced hypertension. The significant role of spinal cord opioids and nociceptin are also reviewed. Although clinical studies of acupuncture to date have met some success, they are rarely scientifically robust and do not feature randomization and long-term follow up. Based on a great deal of basic scientific evidence, large trials are desperately needed to study the effects of acupuncture on the hyperensive man.
Highlights
Hypertension has become a serious public health problem impacting over one billion lives worldwide [1]
We have demonstrated that both low frequency electro- and manual-acupuncture inhibit premotor sympathetic neural firing in the rostral ventrolateral medulla (rVLM) and lower blood pressure (BP) [15]
Microinjection of kainic acid (KA) into the arcuate blocks the inhibitory influence of EA on reflex hypertension. These results suggest that excitatory projections from the arcuate nucleus to the Ventrolateral periaqueductal gray (vlPAG) appear to be essential to the inhibitory influence of EA on the reflex increase in BP induced by painful afferent stimulation
Summary
Hypertension has become a serious public health problem impacting over one billion lives worldwide [1]. At the turn of this century, 7.6 million deaths were attributable to hypertension The majority of this disease burden occurred in working people in low to middle-income countries, while its prevalence increases with age and the lifetime risk of developing hypertension approaches 90% [2]. Current pharmacologic approaches to hypertension include agents that affect myocardial contractility and chronotropy, vascular tone, salt and water retention. All of these pharmaceuticals have numerous side effects, are costly and are often only partially effective requiring treatment with multidrug regimens. The activity of the sympathetic nervous system (SNA) contributes to renin release which in turn leads to increased vascular tone as well as salt retention by increasing the levels of angiotensin and aldosterone. We will describe the central nervous mechanisms of acupuncture and provide the rationale for the use of this technique in the treatment of hypertension
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